Abstract
Patients with in-hospital strokes (IHS) may be eligible for recanalization therapies. The objective of this study is to compare outcomes in patients with IHS and community-onset strokes (COS) treated by recanalization therapy. We analysed data prospectively collected in consecutive patients treated by thrombolysis, thrombectomy, or both for cerebral ischemia at the Lille University Hospital. We compared four outcomes measures at 3 months in patients with IHS and COS: (1) modified Rankin scale (mRS) 0–1, (2) mRS 0–2, (3) death, and (4) symptomatic intracranial haemorrhage (ECASS 2 definition). Of 1209 patients, 64 (5.3%) had IHS, with an increasing proportion over time (p = 0.001). Their median onset-to-needle time was 128 min vs. 145 in COS (p < 0.001). They were more likely to have had a recent TIA [odds ratio (OR) 30.1; 95% confidence interval (CI) 11.5–78.7], to have been treated by vitamin K antagonist before (OR 4.2; 95% CI 1.4–12.0) and to undergo mechanical thrombectomy (45 vs. 10%, p < 0.001). They were less likely to have a pre-stroke mRS 0–1 (OR 0.22; 95% CI 0.09–0.50). After adjustment, IHS was not associated with any of the four outcome measures. Patients with IHS are treated 17 min earlier than patients with COS, but, taking into account that they were already in the hospital, delays are still too long. Their outcome does not differ from that of patients with COS, suggesting room for improvement if delays can be reduced. IHS being frequent, pre-specified pathways should be organised.
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Marc Ferrigno, Anais Hochart, Solène Moulin, Nelly Dequatre, Marie Bodenant, Hilde Hénon, Charlotte Cordonnier, and Didier Leys are investigators of ECASS4 (no honoraria). Didier Leys has been member of scientific advisory boards and symposia for Boehringer-Ingelheim (fees paid to ADRINORD). François Caparros and Amélie Decourcelle declare no conflict of interest.
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The registry was approved by the ethical committee of Lille in 2003 and the study classified as observational (CCPPRB, Comité consultatif de protection des personnes dans la recherche biomédicale).
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INSERM U1171, University of Lille, Lille University Hospital, Adrinord.
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Caparros, F., Ferrigno, M., Decourcelle, A. et al. In-hospital ischaemic stroke treated with intravenous thrombolysis or mechanical thrombectomy. J Neurol 264, 1804–1810 (2017). https://doi.org/10.1007/s00415-017-8570-4
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DOI: https://doi.org/10.1007/s00415-017-8570-4