Background

The benefit of endovascular thrombectomy for patients with in-hospital stroke remains unclear. Thus, the aim of this study was to compare the endovascular thrombectomy outcomes between in-hospital stroke and community-onset stroke among patients with acute ischemic stroke.

Methods

From January 2015 to July 2019, 362 consecutive patients with acute ischemic stroke with large vessel occlusion in the anterior circulation received endovascular thrombectomy in our centre. After propensity score matching with a ratio of 1:2 (in-hospital stroke:community-onset stroke), clinical characteristics and functional outcomes were compared between in-hospital stroke and community-onset stroke groups.

Results

Thirty-six patients with in-hospital stroke and 72 patients with community-onset stroke were enrolled. The number of patients with New York Heart Association classification III/IV (41.7% vs. 6.9%, p < 0.001) and with underlying cancer (25.0% vs. 2.8%, p < 0.001) was higher in the in-hospital stroke than in the community-onset stroke group. The intravenous thrombolysis rate was lower in the in-hospital stroke group (13.9% vs. 43.1%, p = 0.002). No significant difference in symptom onset to puncture (p = 0.618), symptom onset to recanalisation (p = 0.618) or good reperfusion (modified thrombolysis in cerebral infarction ≥2b) rates (p = 0.852) was found between the groups. The favourable clinical outcome trend (modified Rankin scale ≤2 at 90 days) was inferior, but acceptable, in the in-hospital stroke, group compared to the community-onset stroke group (30.6% vs. 41.7%, p = 0.262).

Conclusion

Patients with in-hospital stroke had more disadvantageous comorbidities than those with community-onset stroke. Cardiac dysfunction seems to be associated with poor outcomes after thrombectomy. Nevertheless, endovascular thrombectomy still appears to be safe and effective for patients with in-hospital stroke.

中文翻译：

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血栓切除术后院内卒中与社区发作卒中的结局：倾向评分匹配分析

背景

血管内血栓切除术对院内卒中患者的益处仍不清楚。因此，本研究的目的是比较急性缺血性卒中患者院内卒中和社区发作卒中的血管内血栓切除术结果。

方法

2015年1月至2019年7月，连续362例前循环大血管闭塞的急性缺血性卒中患者在我中心接受了血管内血栓切除术。在以 1:2（院内卒中：社区发作卒中）的比例进行倾向评分匹配后，比较院内卒中和社区发作卒中组的临床特征和功能结果。

结果

纳入了 36 名院内卒中患者和 72 名社区发作卒中患者。纽约心脏协会分级 III/IV（41.7% 对 6.9%，p  < 0.001）和潜在癌症（25.0% 对 2.8%，p  < 0.001）的患者数量在院内卒中高于在社区发作的卒中组中。住院卒中组的静脉溶栓率较低（13.9% 对 43.1%，p  = 0.002）。症状发作至穿刺 ( p  = 0.618)、症状发作至再通 ( p  = 0.618) 或良好再灌注（脑梗塞改良溶栓≥2 b）率无显着差异( p = 0.852) 在组之间被发现。与社区发病卒中组相比，院内卒中组的有利临床结果趋势（90 天时改良 Rankin 量表≤2）较差，但可以接受（30.6% 对 41.7%，p = 0.262 ）  。

结论

与社区发病的卒中患者相比，院内卒中患者有更多不利的合并症。心脏功能障碍似乎与血栓切除术后的不良结果有关。尽管如此，血管内血栓切除术对于院内卒中患者似乎仍然是安全有效的。