From the Department of Radiology, Radiation Oncology and Medical Physics (P.P.-P., S.S, N.O.-F., L.Z., E.P.d.O., V.T.-A., S.C., C.T., R.I.A.), University of Ottawa, Ottawa, Ontario, Canada
Neuroscience Program (P.P.-P., E.P.d.O., S.C., C.T., R.F., D.D., R.I.A.), The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
AJNR Am J Neuroradiol. 2024 Oct 3;45(10):1482-1487. doi: 10.3174/ajnr.A8362.
Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era.
This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney tests.
A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, = .02) and less likely to receive thrombolysis (25% versus 68%, < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, < .001). Successful recanalization was achieved in >75% in both groups ( = .39), with a median NIHSS score at discharge of <4 ( = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group ( = .06).
Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.
既往研究表明，与社区发病的脑卒中患者相比，住院期间发生脑卒中的患者可能会面临治疗延迟和预后更差的情况。然而，大多数研究发生在静脉溶栓治疗是主要治疗手段的时候。本研究旨在探讨血管内取栓治疗时代住院期间发生脑卒中患者的结局。
这是一项单中心回顾性队列研究，纳入了 2015 年 1 月 1 日至 2021 年 4 月 30 日发病 12 小时内接受血管内取栓治疗的年龄大于 18 岁的急性缺血性脑卒中患者。患者分为 2 组：住院期间发生的脑卒中与社区发病的脑卒中。我们比较了卒中护理提供的时间指标、再通率以及 90 天 mRS 评分（良好结局定义为 mRS 0-2）所评估的功能结局。使用 Fisher 确切检验和 检验比较比例差异，使用 Mann-Whitney 检验比较中位数差异。
共纳入 676 例连续患者，其中 69 例（10%）为住院期间发生的脑卒中。与社区发病的脑卒中患者相比，住院期间发生脑卒中的患者更有可能患有糖尿病（36%比 18%， =.02），且更不可能接受溶栓治疗（25%比 68%， <.001），但其他方面相似。住院期间发生脑卒中的患者整体时间指标明显更快，最显著的是从卒中识别到影像检查的时间（中位数，70[四分位距，38-141]分钟比 121[74-228]分钟， <.001）。两组再通率均超过 75%（ =.39），出院时 NIHSS 评分中位数均<4（ =.18）。两组 90 天 mRS 相似，住院期间发生脑卒中组的院内死亡率有升高趋势（ =.06）。
与社区发病的脑卒中患者相比，住院期间发生脑卒中的患者接受血管内取栓治疗的工作流程延迟更短，但再通率和临床结局相似。最重要的是，住院期间发生脑卒中与社区发病的脑卒中患者的 90 天死亡率和 mRS 评分相当。
