No abstract

Background and Purpose Acute strokes due to large vessel occlusion in hospitalized patients is not uncommon. Evidence is limited on the management and outlook of such patients. treatment in these patients. We performed a systematic review and meta-analysis to investigate the benefit and timing of endovascular thrombectomy (EVT) for in-hospital stroke. Methods We conducted a systematic review and meta-analysis of clinical studies of ten patients or more published in English language until March 2020 in the MEDLINE and Cochrane databases. Searches were supplemented by scanning bibliographies of key articles. We included retrospective and prospective studies published in full and reported original data on the characteristics and outcomes of in-hospital stroke patients treated with EVT. Case reports or studies reporting the outcomes of mixed cohorts of intravenous thrombolysis or EVT were excluded if the characteristics of the EVT cohort were not reported separately. Two authors independently selected eligible studies and extracted data. Results Out of 4996 retrieved studies, six studies were included with a total of 111 patients. The median age was 73.7 years (range 58-81 years) and median NIHSS was 17 (range 13-21). Patients were commonly admitted to the cardiology service (24.3%) followed by surgery (17.1%) and hematology (11.7%). The most common stroke etiology was cardioembolic (61.3%) and large artery disease (9%), while 5.4% were malignancy-related. The most common occlusion sites were the middle cerebral (56%) and terminal carotid (28%) arteries. 21.6% received IV tPA. The pooled time from detection/last seen well to puncture was 134 minutes (95% CI: 100.9 to 167.2 minutes) (figure A). Successful reperfusion was described in 81.1.% with a pooled detection to reperfusion time of 191.8 minutes (95% CI: 167.6 to 216.1 minutes). Symptomatic intracranial hemorrhages occurred in 6.3%. The cumulative probability of a good clinical outcome (mRS <3) was 39% (95% CI: 27 to 51%) (figure B) with a cumulative mortality risk of 19% (95% CI: 11 to 27%). Conclusions Despite hospitalization and existing co-morbidities, EVT safety and outcomes in the in-hospital stroke patients with large vessel occlusion are not different from communityonset cases. Noticeable delays from detection to puncture time are reported in the literature which call for better stroke pathways to identify and treat these patients fast.