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Review
. 2024 Jan;26(1):41-53.
doi: 10.5853/jos.2023.01613. Epub 2024 Jan 9.

Mechanical Thrombectomy for In-Hospital Onset Stroke: A Comparative Systematic Review and Meta-Analysis

Melika Amoukhteh  1   2 , Amir Hassankhani  1   2 , Sherief Ghozy  1 , Parya Valizadeh  1 , Payam Jannatdoust  1 , Cem Bilgin  1 , Ramanathan Kadirvel  1   3 , David F Kallmes  1
Affiliations
Review

Mechanical Thrombectomy for In-Hospital Onset Stroke: A Comparative Systematic Review and Meta-Analysis

Melika Amoukhteh et al. J Stroke. 2024 Jan.

Abstract

Background and purpose: In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS).

Methods: We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0.

Results: In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively.

Conclusion: While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.

Keywords: Safety; Stroke; Thrombectomy; Treatment outcome.

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Conflict of interest statement

Conflicts of interest

DFK holds equity in Nested Knowledge, Superior Medical Editors, and Conway Medical, Marblehead Medical; a consultant for MicroVention, Medtronic, Balt, and Insera Therapeutics; Data Safety Monitoring Board for Vesalio; and receiving royalties from Medtronic. RK is contracted/consultant for Cerenovus Inc, Medtronic, Endovascular Engineering, Frontior Bio, Sensome Inc, Endomimetics, Ancure LLC, Neurogami Medical, MIVI Biosciences, Monarch Biosciences, Stryker Inc, Conway Medical, Pireus Medical, and Bionau Labs. All remaining authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram showing the review process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Forest plot of the odds ratio meta-analysis for having a good functional outcome (defined as modified Rankin Scale score ≤2) at discharge (A) and follow-up (B) in mechanical thrombectomy for cases of in-hospital onset stroke (IHOS) compared to community-onset stroke (COS). CI, confidence interval; REML, restricted maximum likelihood.
Figure 3.
Figure 3.
Forest plot of the odds ratio meta-analysis for mortality on follow-up in mechanical thrombectomy in cases of in-hospital onset stroke (IHOS) compared to community-onset stroke (COS). CI, confidence interval; REML, restricted maximum likelihood.
Figure 4.
Figure 4.
Forest plot of the odds ratio meta-analysis for the successful recanalization rate of mechanical thrombectomy in cases of in-hospital onset stroke (IHOS) compared to community-onset stroke (COS). CI, confidence interval; REML, restricted maximum likelihood.
Figure 5.
Figure 5.
Forest plot of odds ratio meta-analysis for periprocedural complications (A) and symptomatic intracranial hemorrhage (B) in mechanical thrombectomy for in-hospital onset stroke (IHOS) compared to community-onset stroke (COS). CI, confidence Interval; REML, restricted maximum likelihood.
See this image and copyright information in PMC

References

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