Other Hospital-onset Acute Ischemic Stroke Due to Large Vessel Occlusion Treated by Mechanical Thrombectomy after Inter-hospital Transfer

Abstract

The purpose of this study was to investigate the in-hospital acute ischemic stroke due to large vessel occlusion (LVO) that developed in another thrombectomy-incapable hospital, treated by mechanical thrombectomy after inter-hospital transfer. In eight other hospital-onset LVO patients, clinical characteristics, treatment results, and the timeline of thrombectomy were retrospectively investigated and compared to the results of 17 patients developed LVO at our own hospital and 18 developed in the community. In the analysis of timeline, the mean recognition-to-arrival time in other hospital-onset patients was 169 ± 78 min, significantly longer than for the community-onset patients (79 ± 78 min). Arrival-to-puncture time was 42 ± 19 min, significantly shorter than for the own hospital-onset patients (166 ± 80 min) and the communityonset patients (155 ± 76 min). Recognition-to-puncture times for the other hospital-onset patients, the own hospital-onset patients, and the community-onset patients were 212 ± 74, 166 ± 80, and 216 ± 83 min, respectively, and recognition-to-recanalization times were 285 ± 73, 200 ± 81, and 275 ± 125 min. Both these times were shorter for the own hospital-onset patients. The rates of modified Rankin Scale (mRS) of 0-2 in the three groups were 12%, 30%, and 23%, respectively. The rate of mRS 0-2 was lowest in the other hospital-onset patients. In conclusion, the other hospital-onset patients required additional time for their initial management and inter-hospital transfer although arrival-to-puncture time was shorter. Favorable outcomes were observed less frequently in them. Improving inter-hospital cooperation systems and to educate the medical staff in a thrombectomy-incapable hospital concerning stroke management is important measures for other hospital-onset stroke with LVO.

Mechanical Thrombectomy for In-Hospital Onset Stroke: A Comparative Systematic Review and Meta-Analysis

“…1,3,18 Several studies have reported that the incidence of periprocedural complications was not significantly higher in IHOS patients compared to patients with COS, and the occurrence of sICHs was evenly distributed between the two groups. [1][2][3][4][5][18][19][20] Our meta-analysis also verified these results.…”

“…Several in-hospital cohorts have reported successful reperfusion grades following mechanical thrombectomy, indicating the technical feasibility of this procedure for IHOS patients [ 1 - 6 , 18 - 20 ]. Our analysis further confirmed the high rate of successful recanalization for mechanical thrombectomy in IHOS cases, which was found to be comparable to that in COS cases.…”

“…Mechanical thrombectomy has also been established as a safe procedure for patients with IHOS in terms of sICH and other procedure-related complications, even in critically ill patients with a higher antithrombotic therapy burden [ 1 , 3 , 18 ]. Several studies have reported that the incidence of periprocedural complications was not significantly higher in IHOS patients compared to patients with COS, and the occurrence of sICHs was evenly distributed between the two groups [ 1 - 5 , 18 - 20 ]. Our meta-analysis also verified these results.…”

Large-Vessel Occlusion Stroke Treated by Endovascular Thrombectomy in Patient with Coronavirus Disease 2019

“…It has been reported that thrombus retrieval therapy for in-hospital stroke with large-vessel occlusion takes longer if the patient must be transferred to another hospital. 10 In our patient, however, COVID-19 could be treated at the first hospital. Because our hospital is a single-specialty neurosurgery hospital, as mentioned previously, it was difficult to treat COVID-19; thus, after the neurosurgery, the patient returned to the general hospital where he had been hospitalized for COVID-19.…”