Mechanical Thrombectomy for Patients with In-Hospital Ischemic Stroke: A Case-Control Study

Zachary Bulwa, Victor J. Del Brutto, Andrea Loggini, Faten El Ammar, Raisa C. Martinez, Gregory Christoforidis, James R. Brorson, Agnieszka A. Ardelt, Fernando D. Goldenberg

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background and Aim: Patients with in-hospital acute ischemic stroke (AIS) have, in general, worse outcomes compared to those presenting from the community, partly attributed to the numerous contraindications to intravenous thrombolysis. We aimed to identify and analyze a group of patients with in-hospital AIS who remain suitable candidates for acute endovascular therapies. Methods: A retrospective 6-year data analysis was conducted in patients evaluated through the in-hospital stroke alert protocol in a single tertiary care university hospital to identify those with in-hospital AIS due to acute intracranial large vessel occlusion (ILVO). Feasibility and safety of mechanical thrombectomy for in-hospital AIS was assessed in a case-control study comparing inpatients to those presenting from the community. Results: From 1460 in-hospital stroke alert activations, 11% had a final diagnosis of AIS (n = 167). One hundred and two patients with in-hospital AIS had emergent intracranial vessel imaging and were included in our cohort. Acute ILVO was identified in 27 patients within this cohort. Patients were younger in the ILVO group and had more severe neurologic deficit on presentation. Compared to a matched (1:2) control group of patients presenting from the community, inpatients who underwent mechanical thrombectomy achieved equivalent technical success, safety, and clinical outcomes. Conclusions: The incidence of acute ILVO in patients with in-hospital AIS who underwent emergent vessel imaging is similar to the reported incidence of ILVO in patients presenting with community-onset AIS. Among patients with in-hospital AIS secondary to ILVO, mechanical thrombectomy is a feasible and safe therapy associated with favorable outcomes.

Original languageEnglish (US)
Article number104692
JournalJournal of Stroke and Cerebrovascular Diseases
Volume29
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Acute ischemic stroke
  • in-hospital stroke
  • large vessel occlusion
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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