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Effectiveness of endovascular treatment for in-hospital stroke vs. community-onset stroke: a propensity score-matched analysis

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Abstract

Background

The effectiveness of endovascular treatment for in-hospital stroke remains debatable. We aimed to compare the outcomes between patients with in-hospital stroke and community-onset stroke who received endovascular treatment.

Methods

This prospective registry-based cohort study included consecutive patients who underwent endovascular treatment from January 2013 to December 2022 and were registered in the Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy study and Yonsei Stroke Cohort. Functional outcomes at day 90, radiological outcomes, and safety outcomes were compared between the in-hospital and community-onset groups using logistic regression and propensity score-matched analysis.

Results

Of 1,219 patients who underwent endovascular treatment, 117 (9.6%) had in-hospital stroke. Patients with in-hospital onset were more likely to have a pre-stroke disability and active cancer than those with community-onset. The interval from the last known well to puncture was shorter in the in-hospital group than in the community-onset group (155 vs. 355 min, p<0.001). No significant differences in successful recanalization or safety outcomes were observed between the groups; however, the in-hospital group exhibited worse functional outcomes and higher mortality at day 90 than the community-onset group (all p<0.05). After propensity score matching including baseline characteristics, functional outcomes after endovascular treatment did not differ between the groups (OR: 1.19, 95% CI 0.78–1.83, p=0.4). Safety outcomes did not significantly differ between the groups.

Conclusion

Endovascular treatment is a safe and effective treatment for eligible patients with in-hospital stroke. Our results will help physicians in making decisions when planning treatment and counseling caregivers or patients.

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Data availability

The supporting data are available from the corresponding author on reasonable request.

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Funding

This study was supported by a faculty research grant from the Yonsei University College of Medicine (6-2022-0170) and grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (RS-2023-00265497).

Author information

Authors and Affiliations

  1. Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Jae Wook Jung, Kwang Hyun Kim, Jaeseob Yun, Hyo Suk Nam, Ji Hoe Heo & Young Dae Kim

  2. Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea

    Hyo Suk Nam, Ji Hoe Heo & Young Dae Kim

  3. Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, South Korea

    Minyoul Baik, Joonsang Yoo & Jinkwon Kim

  4. Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea

    Hyungjong Park, Sung-Il Sohn & Jeong-Ho Hong

  5. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea

    Byung Moon Kim, Dong Joon Kim & JoonNyung Heo

  6. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Oh Young Bang, Woo-Keun Seo & Jong-Won Chung

  7. Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea

    Kyung-Yul Lee & Yo Han Jung

  8. Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea

    Hye Sun Lee

  9. Department of Neurology, Chosun University School of Medicine, Gwangju, South Korea

    Seong Hwan Ahn

  10. Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea

    Dong Hoon Shin

  11. Department of Neurology, Kyung Hee University at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea

    Hye-Yeon Choi

  12. Department of Neurology, Pusan National University School of Medicine, Busan, South Korea

    Han-Jin Cho

  13. Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Jang-Hyun Baek

  14. Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea

    Gyu Sik Kim & Kwon-Duk Seo

  15. Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, South Korea

    Seo Hyun Kim

  16. Department of Neurology, College of Medicine, Seoul Hospital, Ewha Womans University, Seoul, South Korea

    Tae-Jin Song

  17. Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea

    Sang Won Han & Joong Hyun Park

  18. Department of Neurology, Seoul Medical Center, Seoul, South Korea

    Jin Kyo Choi

Authors
  1. Jae Wook Jung
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  2. Kwang Hyun Kim
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  3. Jaeseob Yun
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  4. Hyo Suk Nam
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  6. Minyoul Baik
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  9. Hyungjong Park
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  14. JoonNyung Heo
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  15. Oh Young Bang
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  18. Kyung-Yul Lee
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  19. Yo Han Jung
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  22. Dong Hoon Shin
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  30. Sang Won Han
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  31. Joong Hyun Park
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  32. Jin Kyo Choi
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  33. Young Dae Kim
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Consortia

on behalf of the SECRET Study Group

Contributions

JWJ, KHK, JY, HSN, JHH, and YDK performed data analysis. JWJ, HSN, JHH, MB, JY, JK, HP, S-IS, J-HH, BMK, DJK, JNH, OYB, W-KS, J-WC, K-YL, YHJ, HSL, SHA, DHS, H-YC, H-JC, J-HB, GSK, K-DS, SHK, T-JS, SWH, JHP, JKC, and YDK obtained local data. JWJ, HSL, and YDK wrote the first draft of the manuscript or prepared the figures. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Young Dae Kim.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System (approval no.: 4-2023-0896).

Informed consent

Written informed consent was obtained from prospectively enrolled patients included in the SECRET or Yonsei Stroke Cohort studies or their families, and the institutional review boards of the participating hospitals approved both studies.

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Jung, J.W., Kim, K.H., Yun, J. et al. Effectiveness of endovascular treatment for in-hospital stroke vs. community-onset stroke: a propensity score-matched analysis. J Neurol 271, 2684–2693 (2024). https://doi.org/10.1007/s00415-024-12232-4

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