Objective: Strokes with onset inside the hospital account for approximately 2-17% of all acute ischemic strokes. The few existing studies addressing these in-hospital strokes lack a thorough analysis of patients who underwent endovascular mechanical thrombectomy-the state of the art therapy for acute strokes due to large vessel occlusions. The objective of the study was to evaluate the efficacy and safety of mechanical revascularization therapy in in-hospital stroke patients.
Methods: In a single-center case-control study, a propensity score-matched analysis in a 1:2 ratio with the covariates sex, age, type of occluded large vessel, i.v. thrombolysis, and National Institutes of Health Stroke Scale prior to endovascular mechanical thrombectomy was performed. All identified in-hospital stroke patients between 2010 and 2017 were matched to two consecutive out-of-hospital stroke patients.
Results: 27 in-hospital strokes were compared to 54 out-of-hospital strokes. After propensity score matching, the baseline characteristics were well balanced between these groups. The times for symptom onset to alarm, symptom onset to imaging, symptom onset/alarm to start of recanalization and symptom onset to final recanalization respectively were faster in in-hospital stroke patients. In contrast, the recanalization procedure itself took significantly longer in in-house patients and had a significantly lower rate of technical success resulting in significantly worse clinical outcomes.
Conclusion: The recognition, assessment and pre-interventional procedures of patients with in-hospital strokes and subsequent mechanical thrombectomy are favorable. Nevertheless, in-hospital stroke patients display inferior recanalization results and poorer clinical outcomes. Furthermore, we find mechanical thrombectomy seems safe for treatment of in-hospital strokes.
Keywords: Acute stroke; In hospital stroke; Outcomes; Reperfusion; Safety; Thrombectomy.