Comparison Between In-Hospital and Community-Onset Stroke Treated With Endovascular Thrombectomy: A Propensity...

Area of Science:

• Neurology
• Cardiovascular Diseases
• Public Health

Background:

• In-hospital stroke (IHS) patients often have complex health issues and delayed recognition compared to community-onset stroke (COS).
• The safety and feasibility of endovascular thrombectomy (EVT) for acute ischemic stroke in IHS patients are not well-established.
• This study compares EVT workflow and outcomes in IHS versus COS patients.

Purpose of the Study:

• To compare the procedural, functional, and safety outcomes of EVT in patients with IHS versus COS.
• To evaluate the feasibility and safety of EVT for acute ischemic stroke presenting during hospital admission.
• To identify potential differences in workflow and clinical outcomes between IHS and COS patients undergoing EVT.

Main Methods:

• Utilized data from a national stroke registry (October 2015 - March 2020).
• Employed propensity score matching for individual-level data of patients undergoing EVT.
• Performed univariate analysis to assess procedural, functional, and safety outcomes.

Main Results:

• Included 4353 patients (249 IHS, 4104 COS; matched to 249 IHS, 249 COS).
• No significant differences observed in modified Rankin Scale scores at discharge or 6 months between IHS and COS groups.
• Similar rates of good functional outcome, successful reperfusion, symptomatic intracranial hemorrhage, and in-hospital mortality were found. IHS group showed a shorter onset-to-imaging time.

Conclusions:

• EVT is safe and feasible for patients experiencing stroke during hospitalization (IHS).
• Functional and safety outcomes for EVT in IHS are comparable to those in COS patients.
• Improving inpatient stroke recognition and reperfusion treatment initiation is crucial for eligible IHS patients.