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Comparative Study
. 2019 Apr 12;14(4):e0214883.
doi: 10.1371/journal.pone.0214883. eCollection 2019.

Comparison between in-hospital stroke and community-onset stroke treated with endovascular thrombectomy

Min-Yi Lu  1 , Chih-Hao Chen  2   3 , Shin-Joe Yeh  2 , Li-Kai Tsai  2 , Chung-Wei Lee  4 , Sung-Chun Tang  2 , Jiann-Shing Jeng  2
Affiliations
Comparative Study

Comparison between in-hospital stroke and community-onset stroke treated with endovascular thrombectomy

Min-Yi Lu et al. PLoS One. .

Abstract

Objective: In-hospital stroke (IHS) is an uncommon but serious medical emergency. Early recanalization through endovascular thrombectomy (EVT) may offer a vital therapeutic choice. This study compared the clinical features and outcomes between IHS and community-onset stroke (COS).

Methods: From a single-center registry of 2813 patients with ischemic stroke, those who had received EVT for acute ischemic stroke were included and classified into the IHS and COS groups based on their stroke onset scenario. We compared the outcomes including successful recanalization, symptomatic intracranial hemorrhage, functional independence (modified Rankin Scale score, 0-2) at 90 days, and mortality between the two groups.

Results: A total of 24 patients with IHS (mean age, 70 years; 54% men) and 105 patients with COS (mean age, 73 years; 47% men) were included. The most frequently reported reasons for admission in patients with IHS were cardiovascular and oncological diseases. The initial National Institutes of Health Stroke Scale (NIHSS) scores and main occluded vessels were similar between the two groups. Patients with IHS received a higher number of active malignancy diagnoses, were more likely to withhold antithrombotic agents, and exhibited higher prestroke functional dependency. The median onset-to-puncture time was 192 min in IHS and 217 min in COS (P = 0.15). The percentages of successful recanalization (79% vs 71%), symptomatic hemorrhage (0% vs 9%), functional independence (42% vs 40%), and mortality (17% vs 12%) were comparable between the two groups. After adjustment for covariates, initial NIHSS scores and successful recanalization were the most important predictors for functional independence at 90 days.

Conclusions: Despite having disadvantages at baseline, patients with IHS could still benefit from timely EVT to achieve favorable outcomes. A well-designed acute stroke protocol tailored for IHS should be developed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of the workflow time intervals of endovascular thrombectomy in patients with IHS and COS.
Fig 2
Fig 2. Functional outcome at 3 months evaluated by whole spectrum modified Rankin scale between patients with IHS and COS.
See this image and copyright information in PMC

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