Mechanical thrombectomy for in-hospital stroke : data from the Italian Registry of Endovascular Treatment in Acute Stroke
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: The benefit, safety, and time intervals of mechanical thrombectomy (MT) in patients with in-hospital stroke (IHS) are unclear. We sought to evaluate the outcomes and treatment times for IHS patients compared with out-of-hospital stroke (OHS) patients receiving MT.
METHODS: We analyzed data from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) between 2015 and 2019. We compared the functional outcomes (modified Rankin Scale (mRS) scores) at 3 months, recanalization rates, and symptomatic intracranial hemorrhage (sICH) after MT. Time intervals from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were recorded for both groups, as were door-to-imaging and door-to-groin for OHS. A multivariate analysis was performed.
RESULTS: Of 5619 patients, 406 (7.2%) had IHS. At 3 months, IHS patients had a lower rate of mRS 0-2 (39% vs 48%, P<0.001) and higher mortality (30.1% vs 19.6%, P<0.001). Recanalization rates and sICH were similar. Time intervals (min, median (IQR)) from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were favorable for IHS (60 (34-106) vs 123 (89-188.5); 150 (105-220) vs 220 (168-294); 227 (164-303) vs 293 (230-370); all P<0.001), whereas OHS had lower door-to-imaging and door-to-groin times compared with stroke onset-to-imaging and onset-to-groin for IHS (29 (20-44) vs 60 (34-106), P<0.001; 113 (84-151) vs 150 (105-220); P<0.001). After adjustment, IHS was associated with higher mortality (aOR 1.77, 95% CI 1.33 to 2.35, P<0.001) and a shift towards worse functional outcomes in the ordinal analysis (aOR 1.32, 95% CI 1.06 to 1.66, P=0.015).
CONCLUSION: Despite favorable time intervals for MT, IHS patients had worse functional outcomes than OHS patients. Delays in IHS management were detected.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
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| Enthalten in: |
Journal of neurointerventional surgery - 15(2023), e3 vom: 21. Dez., Seite e426-e432 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Naldi, Andrea [VerfasserIn] |
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| Anmerkungen: |
Date Completed 25.12.2023 Date Revised 25.12.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/jnis-2022-019939 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM353880906 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: The benefit, safety, and time intervals of mechanical thrombectomy (MT) in patients with in-hospital stroke (IHS) are unclear. We sought to evaluate the outcomes and treatment times for IHS patients compared with out-of-hospital stroke (OHS) patients receiving MT | ||
| 520 | |a METHODS: We analyzed data from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) between 2015 and 2019. We compared the functional outcomes (modified Rankin Scale (mRS) scores) at 3 months, recanalization rates, and symptomatic intracranial hemorrhage (sICH) after MT. Time intervals from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were recorded for both groups, as were door-to-imaging and door-to-groin for OHS. A multivariate analysis was performed | ||
| 520 | |a RESULTS: Of 5619 patients, 406 (7.2%) had IHS. At 3 months, IHS patients had a lower rate of mRS 0-2 (39% vs 48%, P<0.001) and higher mortality (30.1% vs 19.6%, P<0.001). Recanalization rates and sICH were similar. Time intervals (min, median (IQR)) from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were favorable for IHS (60 (34-106) vs 123 (89-188.5); 150 (105-220) vs 220 (168-294); 227 (164-303) vs 293 (230-370); all P<0.001), whereas OHS had lower door-to-imaging and door-to-groin times compared with stroke onset-to-imaging and onset-to-groin for IHS (29 (20-44) vs 60 (34-106), P<0.001; 113 (84-151) vs 150 (105-220); P<0.001). After adjustment, IHS was associated with higher mortality (aOR 1.77, 95% CI 1.33 to 2.35, P<0.001) and a shift towards worse functional outcomes in the ordinal analysis (aOR 1.32, 95% CI 1.06 to 1.66, P=0.015) | ||
| 520 | |a CONCLUSION: Despite favorable time intervals for MT, IHS patients had worse functional outcomes than OHS patients. Delays in IHS management were detected | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Intervention | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombectomy | |
| 700 | 1 | |a Pracucci, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Cavallo, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Saia, Valentina |e verfasserin |4 aut | |
| 700 | 1 | |a Boghi, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Lochner, Piergiorgio |e verfasserin |4 aut | |
| 700 | 1 | |a Casetta, Ilaria |e verfasserin |4 aut | |
| 700 | 1 | |a Sallustio, Fabrizio |e verfasserin |4 aut | |
| 700 | 1 | |a Zini, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Fainardi, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Cappellari, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Tassi, Rossana |e verfasserin |4 aut | |
| 700 | 1 | |a Bracco, Sandra |e verfasserin |4 aut | |
| 700 | 1 | |a Bigliardi, Guido |e verfasserin |4 aut | |
| 700 | 1 | |a Vallone, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Nencini, Patrizia |e verfasserin |4 aut | |
| 700 | 1 | |a Bergui, Mauro |e verfasserin |4 aut | |
| 700 | 1 | |a Mangiafico, Salvatore |e verfasserin |4 aut | |
| 700 | 1 | |a Toni, Danilo |e verfasserin |4 aut | |
| 700 | 0 | |a Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Naldi, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Pracucci, Giovanni |e investigator |4 oth | |
| 700 | 1 | |a Cavallo, Roberto |e investigator |4 oth | |
| 700 | 1 | |a Saia, Valentina |e investigator |4 oth | |
| 700 | 1 | |a Boghi, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Lochner, Piergiorgio |e investigator |4 oth | |
| 700 | 1 | |a Casetta, Ilaria |e investigator |4 oth | |
| 700 | 1 | |a Sallustio, Fabrizio |e investigator |4 oth | |
| 700 | 1 | |a Zini, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Fainardi, Enrico |e investigator |4 oth | |
| 700 | 1 | |a Cappellari, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Tassi, Rossana |e investigator |4 oth | |
| 700 | 1 | |a Bracco, Sandra |e investigator |4 oth | |
| 700 | 1 | |a Bigliardi, Guido |e investigator |4 oth | |
| 700 | 1 | |a Vallone, Stefano |e investigator |4 oth | |
| 700 | 1 | |a Nencini, Patrizia |e investigator |4 oth | |
| 700 | 1 | |a Bergui, Mauro |e investigator |4 oth | |
| 700 | 1 | |a Mangiafico, Salvatore |e investigator |4 oth | |
| 700 | 1 | |a Toni, Danilo |e investigator |4 oth | |
| 700 | 1 | |a Castellano, Davide |e investigator |4 oth | |
| 700 | 1 | |a Ciolli, Ludovico |e investigator |4 oth | |
| 700 | 1 | |a Bosco, Giovanni |e investigator |4 oth | |
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| 700 | 1 | |a Giannini, Nicola |e investigator |4 oth | |
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