Background: Endovascular clot retrieval (ECR) may benefit in-hospital strokes (IHS) ineligible for thrombolysis.
Aims: To compare ECR outcomes in inpatient and community-onset strokes (COS) at our comprehensive stroke centre.
Method: Retrospective review of strokes from 01/01/2020 to 29/02/2024 using AusCR data.
Results: We identified 45 (3.7%) ischaemic IHS and ischaemic 1173 COS over this 38-month period. IHS exhibited greater stroke severity (NIHSS 15 vs 4), baseline disability (mRS 1 vs 0), and inpatient mortality (27% vs 8%) than COS. Despite their higher rates of ECR (31% vs 13%) and successful reperfusion (93% vs 84% achieved eTICI >2a), IHS incurred far higher post-ECR mortality than COS (43% vs 17%). This poorer outcome may reflect a greater pre-ECR NIHSS (21 vs 15) and delayed onset-to-puncture and revascularization compared to traditional door-to-puncture and revascularization times for COS (199 vs 127 mins and 300 vs 178 mins respectively). IHS more frequently developed large vessel occlusions (44% vs 10%), likely explaining their greater access to thrombectomy. Thrombolysis rates were equal (13% vs 15%). The leading thrombolytic contraindications for IHS was recent surgery (27%), then large/established infarct (18%), anticoagulation (18%), and prior intracranial bleeding/stroke (16%). Overall, outcomes favoured post-procedural strokes (17% mortality) and were poorest in ICU strokes (50% mortality).
Conclusion: Despite high rates of ECR and successful reperfusion, IHS confers a higher mortality than COS. This likely reflects acute co-morbidity, greater stroke severity, and delayed reperfusion from onset. This data is useful in managing expectation of outcomes of ECR in IHS and warrants further research.