Workflow and Outcomes of Endovascular Thrombectomy for In-Hospital Stroke a Systematic Review and Meta-Analysis

Almutairi, Salem; Choudhury, H; Najm, Mohamed; Bala, Fouzi; Almekhlafi, Mohammed

doi:10.1016/j.jstrokecerebrovasdis.2021.105937

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Standardized guidelines for IHOS management aligning with COS time metrics are essential for consistent and effective care. Incorporating cost-effective technologies like portable imaging devices could aid in early stroke detection, especially in high-risk wards [ 23 ]. Moreover, quality improvement initiatives for IHOS protocols have proven effective in reducing time delays without compromising patient safety [ 22 ], likely benefiting the functional outcomes of mechanically thrombectomized IHOS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, workflow times should be significantly faster for IHOS patients, considering their hospitalization. Given the high frequency of unfavorable outcomes in IHOS patients, [21][22][23] enhancing the efficiency of inhospital stroke workflows becomes a top priority. This involves streamlining stroke team notification and emergency imaging for expedited IHOS diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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

Amoukhteh,

Hassankhani,

Ghozy

et al. 2024

J Stroke

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Background and Purpose In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS).Methods We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0.Results In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively.Conclusion While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Amoukhteh,

Hassankhani,

Ghozy

et al. 2024

J Stroke

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“…Few patients (12%) with IHS are eligible for IVT due to preexisting comorbidities, worrying medical situations, or a recent surgery history 2–4 . Recently, multiple previous studies demonstrated that EVT showed similar safety and effectiveness for IHS patients presented with LVO 6–8,24,25 . Therefore, an LVO recognition tool to help identify LVO from inpatients' stroke alerts, reduce delays, and increase the proportion of patients eligible for EVT is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Recently, multiple previous studies demonstrated that EVT showed similar safety and effectiveness for IHS patients with LVO. [6][7][8]24,25 Therefore, an LVO recognition tool to help identify LVO from inpatients' stroke alerts, reduce delays, and increase the proportion of patients eligible for EVT is necessary. It is particularly important to predict the presence of LVO for timely activating appropriate stroke teams.…”

Section: Discussionmentioning

confidence: 99%

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Qiu¹,

Ke²,

Jia³

et al. 2023

J Comput Assist Tomogr

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Objectives: A large quantity of ischemic stroke events occur in patients hospitalized for non-stroke-related reason. No scale has been developed to identify the large vessel occlusion (LVO) among inpatient stroke alerts. We aimed to develop a novel evaluation scale to predict LVO from in-hospital stroke alerts.Methods: Data from consecutive in-hospital stroke alerts were analyzed at a single high volume stroke center between January 2016 and October 2020. We developed a predictive scale based on the first half of patients (training group) using multivariate logistic regression and evaluated it in the remaining half of patients (validation group) adopting receiver operating curve. Receiver operating characteristics of the scale were analyzed to evaluate its value for the detection of LVO.Results: A total of 243 patients were enrolled for further study, among them, 94 (38.7%) had confirmed LVO. Three risk factors independently predicted the presence of LVO: recent cardiac or pulmonary procedure (1 point), neurological deficit scale (≥1: 2 points), and history of atrial fibrillation (1 point). The CAPS scale was generated based on predictive factors and demonstrated highly effective discrimination in identifying the presence of LVO in the training group (area under curve = 0.956) and the validation group (area under curve = 0.940). When the score ≥2, CAPS scale showed 97.9% sensitivity, 79.2% specificity, 74.8% positive predictive value, and 98.3% negative predictive value for discriminating LVO.Conclusions: CAPS scale was developed for identifying LVO among inpatient stroke alerts with high sensitivity and specificity, which may help to quickly prompt responses by appropriate stroke teams.

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

Jung,

Kim,

Yun

et al. 2024

J Neurol

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Workflow and Outcomes of Endovascular Thrombectomy for In-Hospital Stroke a Systematic Review and Meta-Analysis

Cited by 5 publications

References 28 publications

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

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

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

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

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