E5534. Comparative Systematic Review and Meta-Analysis of Mechanical Thrombectomy in Cases of In-Hospital Onset Stroke
Authors
Amir Hassankhani;
Mayo Clinic
Melika Amoukhteh;
Mayo Clinic
Sherief Ghozy;
Mayo Clinic
David Kallmes;
Mayo Clinic
Objective:
In the realm of acute ischemic strokes caused by large vessel occlusion, a notable fraction is attributed to in-hospital onset stroke (IHOS), which often results in poorer outcomes due to delays in assessment and treatment. There exists a scarcity of comprehensive data regarding the effectiveness of mechanical thrombectomy in treating IHOS patients. The aim of this study is to evaluate the safety and effectiveness of mechanical thrombectomy in patients with IHOS and compare the outcomes of IHOS and community onset strokes (COS).
Materials and Methods:
In accordance with established protocols, we performed a systematic review and meta-analysis by thoroughly searching databases including PubMed, Scopus, Web of Science, and Embase through April 11, 2023. Studies meeting the criteria and reporting relevant outcomes were incorporated, and pertinent data were extracted and subjected to analysis using STATA software version 17.0.
Results:
In a comprehensive meta-analysis involving nine studies, which encompassed 540 cases of IHOS and 5744 cases of COS, it was found that IHOS cases exhibited a significantly lower rate of positive functional outcomes during follow-up (35.46% compared to 40.74%, p < 0.01) and a higher mortality rate during follow-up (26.29% versus 18%, p < 0.01) in comparison to COS patients. Notably, both groups showed similar rates of successful recanalization (IHOS: 79.32% versus COS: 81.4%, p = 0.11), incidences of periprocedural complications (IHOS: 15.1%, COS: 12.9%, p = 0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.8%, p = 0.7). It's important to highlight that a significant portion of the observed effect size for mortality and favorable functional outcomes during follow-up was derived from only one and two studies, respectively.
Conclusion:
Although existing literature indicates the safety and efficacy of mechanical thrombectomy as a treatment for IHOS, additional research is required to thoroughly assess its impact, especially in the context of follow-up evaluations.
