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. 2022 Aug;8(3):73-78.
doi: 10.20407/fmj.2021-014. Epub 2021 Nov 25.

Delays in initial workflow cause delayed initiation of mechanical thrombectomy in patients with in-hospital ischemic stroke

Kenichiro Suyama  1 , Shoji Matsumoto  1 , Ichiro Nakahara  1 , Yoshio Suyama  1 , Jun Morioka  1 , Akiko Hasebe  1 , Jun Tanabe  1 , Sadayoshi Watanabe  1 , Kiyonori Kuwahara  1 , Yuichi Hirose  2
Affiliations

Delays in initial workflow cause delayed initiation of mechanical thrombectomy in patients with in-hospital ischemic stroke

Kenichiro Suyama et al. Fujita Med J. 2022 Aug.

Abstract

Objectives: The benefit of mechanical thrombectomy for acute ischemic stroke is highly time dependent. However, time to treatment is longer for in-hospital stroke patients than community-onset stroke patients. This study aimed to clarify the cause of this difference.

Methods: A retrospective single-center study was performed to analyze patients with large vessel occlusion who underwent mechanical thrombectomy between January 2017 and December 2019. Patients were divided into in-hospital stroke and community-onset stroke groups. Clinical characteristics and treatment time intervals were compared between groups.

Results: One hundred four patients were analyzed: 17 with in-hospital stroke and 87 with community-onset stroke. Patient characteristics did not significantly differ between groups. Median door (stroke recognition)-to-computed tomography time (36 min vs. 14 min, P<0.01) and door-to-puncture time (135 min vs. 117 min, P=0.02) were significantly longer in the in-hospital stroke group than the community-onset stroke group. However, median computed tomography-to-puncture time (104 min vs. 104 min, P=0.47) and puncture-to-reperfusion time (53 min vs. 38 min, P=0.17) did not significantly differ.

Conclusions: Longer door-to-puncture time in in-hospital stroke patients was mostly caused by longer door-to-computed tomography time, which is the initial part of the workflow. An in-hospital stroke protocol that places importance on early stroke specialist consultation and prompt transportation to the computed tomography scanner might hasten treatment and improve outcomes in patients with in-hospital stroke.

Keywords: Community-onset stroke; In-hospital stroke; Mechanical thrombectomy; Treatment time intervals.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of treatment time intervals between the IHS and COS groups. Box-and-whisker plots of the time from (A) door to computed tomography (CT), (B) door to puncture, (C) CT to puncture, and (D) puncture to reperfusion. The horizontal line within the box represents the median and the top and bottom edges of each box indicate the interquartile range. Door-to-CT and door-to-puncture times were significantly longer in the IHS group than the COS group. * Significant difference with P<0.05. ** Significant difference with P<0.01. COS, community-onset stroke; IHS, in-hospital stroke; LWK, last well known
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