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Objective:
In-hospital onset stroke (IHOS) cases display distinct risk factors and characteristics that make them more susceptible to unfavorable outcomes in comparison to strokes that originate in the community (COS). Research indicates IHOS patients are more likely to have conditions that contraindicate thrombolysis, prompting the investigation of endovascular thrombectomy (EVT) as a potential treatment avenue. The prompt diagnosis and application of EVT have displayed potential in enhancing patient outcomes. Given the gaps in our current understanding, we conducted a thorough review and meta-analysis to comprehensively examine the EVT process for patients with IHOS in comparison to those with COS.

Materials and Methods:
Following the PRISMA statement guidelines, a thorough exploration of the literature was carried out on April 11, 2023, spanning various databases such as PubMed, Scopus, Web of Science, and Embase. The search approach utilized precise terms related to IHOS and mechanical thrombectomy. All studies meeting the eligibility standards and providing pertinent outcome information were incorporated, with pertinent data points being extracted accordingly.

Results:
The present study included 540 instances of IHOS and 5744 instances of COS. The analysis unveiled that IHOS cases encountered a substantial delay in undergoing cranial imaging from the point of identification when compared to COS cases. This delay exhibited a median of 25.8 minutes (95% CI: 18.8–32.7, p < 0.01, I2 = 48%). Conversely, IHOS cases achieved recanalization around 62.8 minutes sooner than COS cases, calculated from the time of onset (last known well) (95% CI: 14.3–111.2, p = 0.02, I2 = 65.5%). Similarly, IHOS cases accomplished recanalization significantly earlier by 28.2 minutes than COS cases from the time of groin puncture (95% CI: 45.7–10.7, p < 0.01, I2 = 58%). Although the meta-analysis did not identify a noteworthy distinction in the time intervals spanning the stroke's onset to groin puncture between the two groups (difference of medians: -24.08 minutes, 95% CI: -51.7–3.6, p = 0.09, I2 = 58%), there appeared to be a nonsignificant tendency towards a shorter interval from the stroke's onset to groin puncture in IHOS cases (p = 0.09). Furthermore, the meta-analysis findings disclosed no significant variances in the time intervals from the stroke's onset to identification (difference of medians: -27.5 minutes, 95% CI: -92.4–37.4, p = 0.41, I2 = 84%), from the stroke's onset to imaging (difference of medians: -45.54 minutes, 95% CI: -103.5 to 12.7, p = 0.13, I2 = 92.2%), and from identification to groin puncture (difference of medians: 17.76 minutes, 95% CI: -9.8 to 45.3, p = 0.21, I2 = 68%).

Conclusion:
Considering the elevated occurrence of unfavorable results in patients experiencing IHOS, prioritizing the improvement of stroke workflows within hospital environments becomes imperative.