In-Hospital Strokes Demonstrate Improved Outcomes with Mechanical Thrombectomy

Abstract

Objective— Patients with in-hospital stroke often have contraindications to intravenous alteplase(1), (2).
Mechanical thrombectomy is a treatment option, even for patients otherwise ineligible for intravenous alteplase. We
compare outcomes between mechanical thrombectomy performed in patients with strokes that occurred in-hospital
versus community-onset strokes.
Methods— This is an Institutional Review Board-approved, retrospective cross-sectional study analyzing patients
who underwent thrombectomy for acute ischemic stroke with large vessel occlusion between January 2012 and
November 2017 at Tampa General Hospital. We performed logistic regression analysis to compare the outcomes
between patients with in-hospital stroke and community-onset stroke after adjusting for potential confounders.
Results— A total of 334 patients received mechanical thrombectomy for acute ischemic stroke: 13.2% were in-hos
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pital and 86.8% were community-onset. Patients who presented with strokes that occurred in-hospital were signifi
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cantly younger (mean age 60.7 vs. 70.4 years; p<0.001). In-hospital stroke treated with mechanical thrombectomy
had lower pretreatment with intravenous alteplase (14% vs. 34%; p=0.006). Patients with in-hospital stroke had a
significantly shorter time interval between symptom recognition and groin puncture (p=0.039). Also, in-hospital
stroke patients had significantly higher rates of favorable outcomes at discharge as measured by the modified Rankin
scale 0–3 (52% vs. 32%; p=0.009) and continued to have favorable outcomes (adjusted odds ratios =4.832; 95% Cl,
(1.207-19.348); P=0.026) after adjustment for age and National Institute of Health Stroke Scale which were felt to
be potential confounders.
Conclusions— Compared with patients with community-onset stroke, patients with in-hospital stroke who
underwent thrombectomy had higher rates of favorable outcomes at discharge.