Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Cummings School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Cummings School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105937. doi: 10.1016/j.jstrokecerebrovasdis.2021.105937. Epub 2021 Jun 24.
Acute strokes due to large vessel occlusion in hospitalized patients is not uncommon. We performed a systematic review and meta-analysis to investigate the timing and outcome of endovascular thrombectomy (EVT) for in-hospital stroke.
We conducted a meta-analysis of clinical studies published in English until September 2020 in the MEDLINE and Cochrane databases. Studies reporting original data on the characteristics and outcomes of in-hospital stroke patients treated with EVT were included. We extracted data on the time-metrics from last known well (LKW) until reperfusion was achieved. We also collected data on procedural and functional outcomes.
Out of 5093 retrieved studies, 8 were included (2,622 patients). The median age was 71.4 years and median NIHSS score on admission was 16. Patients were mostly admitted to the cardiology service (27.3%). The pooled time from LKW to recognition by staff was 72.9 min (95% CI: 40.7 to 105 min). 25.6% received IV tPA. The mean time from stroke recognition to arterial puncture was 134.5 min (95% CI: 94.9 to 174.1). Successful reperfusion occurred in 82.8.% with a pooled mean time from detection to reperfusion of 193.1 min (95% CI: 139.5 to 246.7). The 90-day independent functional outcome was reported in 42% of patients (95% CI 29 to 55%).
EVT can be performed safely and successfully for in-hospital strokes. Noticeable delays from LKW to detection and then to puncture are noted. This calls for better stroke pathways to identify and treat these patients.
Stroke in hospitalized patients, referred to as in-hospital stroke (IHS), accounts for 2.2-17% of all strokes. The majority of these are ischemic while intracranial hemorrhage represents 2-11% of all IHS. These patients are expected to have a rapid diagnosis and treatment given the ongoing medical supervision, and therefore favorable outcomes. However, existing studies report poor outcomes in patients with IHS with a mortality risk that exceeds that of community-onset stroke (COS): 24.7% vs 9.6%. Surviving IHS patients are also less likely to be discharged home compared to COS (27.7% vs 49.9%) and to be functionally independent at 3 months (31.0% vs 50.4%)..
在住院患者中，由于大血管闭塞引起的急性脑卒中并不少见。我们进行了一项系统评价和荟萃分析，以研究血管内血栓切除术（EVT）治疗住院卒中的时机和结果。
我们对截至 2020 年 9 月在 MEDLINE 和 Cochrane 数据库中发表的英文临床研究进行了荟萃分析。纳入了报告接受 EVT 治疗的住院卒中患者特征和结局的原始数据的研究。我们从最后一次明确（LKW）到再灌注成功的时间指标中提取数据。我们还收集了手术和功能结局的数据。
在 5093 项检索研究中，有 8 项符合纳入标准（2622 例患者）。中位年龄为 71.4 岁，入院时 NIHSS 评分为 16。患者主要被收入心内科（27.3%）。从 LKW 到工作人员识别的中位时间为 72.9 分钟（95%CI：40.7 至 105 分钟）。25.6%接受了 IV tPA。从卒中识别到动脉穿刺的平均时间为 134.5 分钟（95%CI：94.9 至 174.1 分钟）。成功再灌注的比例为 82.8%，从检测到再灌注的平均时间为 193.1 分钟（95%CI：139.5 至 246.7 分钟）。90 天独立功能结局的报告率为 42%（95%CI：29%至 55%）。
EVT 可安全有效地用于治疗住院脑卒中。从 LKW 到检测再到穿刺，存在明显的延迟。这需要更好的脑卒中通路来识别和治疗这些患者。
住院患者脑卒中（IHS）又称住院期间脑卒中，占所有脑卒中的 2.2-17%。这些患者大多数为缺血性脑卒中，而颅内出血占所有 IHS 的 2-11%。由于这些患者正在接受医疗监护，因此应尽快做出诊断和治疗，以获得良好的预后。然而，现有研究报告称，IHS 患者的结局较差，死亡率超过社区发病脑卒中（COS）：24.7%比 9.6%。与 COS 相比，存活的 IHS 患者出院回家的可能性更低（27.7%比 49.9%），3 个月时功能独立的可能性也更低（31.0%比 50.4%）。
