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Ischemic stroke
Original research
Mechanical thrombectomy for in-hospital stroke: data from the Italian Registry of Endovascular Treatment in Acute Stroke
  1. Andrea Naldi1,
  2. Giovanni Pracucci2,
  3. Roberto Cavallo1,
  4. Valentina Saia3,
  5. Andrea Boghi4,
  6. Piergiorgio Lochner5,
  7. Ilaria Casetta6,
  8. Fabrizio Sallustio7,
  9. Andrea Zini8,
  10. Enrico Fainardi9,
  11. Manuel Cappellari10,
  12. Rossana Tassi11,
  13. Sandra Bracco12,
  14. Guido Bigliardi13,
  15. Stefano Vallone14,
  16. Patrizia Nencini15,
  17. Mauro Bergui16,
  18. Salvatore Mangiafico17,
  19. Danilo Toni18
  20. on behalf of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Investigators
    1. 1 Neurology Unit, Ospedale San Giovanni Bosco, Torino, Piemonte, Italy
    2. 2 Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
    3. 3 Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
    4. 4 Radiology and Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
    5. 5 Department of Neurology, Saarland University Medical Center, University of the Saarland, Homburg, Germany
    6. 6 Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
    7. 7 Unità di Trattamento Neurovascolare, Ospedale dei Castelli-ASL6, Rome, Italy
    8. 8 IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
    9. 9 Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Florence, Italy
    10. 10 Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
    11. 11 Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
    12. 12 UO Neurointerventistica, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
    13. 13 Neurologia/Stroke Unit, Ospedale Civile di Baggiovara, AOU Modena, Modena, Italy
    14. 14 Neuroradiologia, Ospedale Civile di Baggiovara, AOU Modena, Modena, Italy
    15. 15 Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
    16. 16 Interventional Neuroradiology Unit, Città della Salute e della Scienza – Molinette, Turin, Italy
    17. 17 Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
    18. 18 Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
    1. Correspondence to Dr Andrea Naldi, Neurology Unit, Ospedale San Giovanni Bosco, 10154 Torino, Piemonte, Italy; naldi.andrea{at}yahoo.it

    Abstract

    Background The benefit, safety, and time intervals of mechanical thrombectomy (MT) in patients with in-hospital stroke (IHS) are unclear. We sought to evaluate the outcomes and treatment times for IHS patients compared with out-of-hospital stroke (OHS) patients receiving MT.

    Methods We analyzed data from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) between 2015 and 2019. We compared the functional outcomes (modified Rankin Scale (mRS) scores) at 3 months, recanalization rates, and symptomatic intracranial hemorrhage (sICH) after MT. Time intervals from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were recorded for both groups, as were door-to-imaging and door-to-groin for OHS. A multivariate analysis was performed.

    Results Of 5619 patients, 406 (7.2%) had IHS. At 3 months, IHS patients had a lower rate of mRS 0–2 (39% vs 48%, P<0.001) and higher mortality (30.1% vs 19.6%, P<0.001). Recanalization rates and sICH were similar. Time intervals (min, median (IQR)) from stroke onset-to-imaging, onset-to-groin, and onset-to-end MT were favorable for IHS (60 (34–106) vs 123 (89–188.5); 150 (105–220) vs 220 (168–294); 227 (164–303) vs 293 (230–370); all P<0.001), whereas OHS had lower door-to-imaging and door-to-groin times compared with stroke onset-to-imaging and onset-to-groin for IHS (29 (20–44) vs 60 (34–106), P<0.001; 113 (84–151) vs 150 (105–220); P<0.001). After adjustment, IHS was associated with higher mortality (aOR 1.77, 95% CI 1.33 to 2.35, P<0.001) and a shift towards worse functional outcomes in the ordinal analysis (aOR 1.32, 95% CI 1.06 to 1.66, P=0.015).

    Conclusion Despite favorable time intervals for MT, IHS patients had worse functional outcomes than OHS patients. Delays in IHS management were detected.

    • Stroke
    • Thrombectomy
    • Intervention

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2022-019939

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • SM and DT are joint senior authors.

      • MB, SM and DT contributed equally.

      • Collaborators Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Investigators: Andrea Naldi, Giovanni Pracucci, Roberto Cavallo, Valentina Saia, Andrea Boghi, Piergiorgio Lochner, Ilaria Casetta, Fabrizio Sallustio, Andrea Zini, Enrico Fainardi, Manuel Cappellari, Rossana Tassi, Sandra Bracco, Guido Bigliardi, Stefano Vallone, Patrizia Nencini, Mauro Bergui, Salvatore Mangiafico, Danilo Toni.Collaborators:Davide Castellano, Ludovico Ciolli, Giovanni Bosco, Riccardo Russo, Francesco Capasso, Roberto Menozzi, Umberto Scoditti, Sergio Lucio Vinci, Ludovica Ferraù, Lucio Castellan, Laura Malfatto, Guido Andrea Lazzarotti, Nicola Giannini, Maria Ruggiero, Marco Longoni, Andrea Saletti, Alessandro De Vito, Alessio Comai, Enrica Franchini, Nicola Cavasin, Adriana Critelli, Daniele G Romano, Rosa Napoletano, Mauro Plebani, Luigi Chiumarulo, Marco Petruzzellis, Vittorio Semeraro, Giovanni Boero, Francesco Taglialatela, Andrea Calzoni, Tiziana Tassinari, Andrea Giorgianni, Lucia Princiotta Cariddi, Marta Iacobucci, Ettore Nicolini, Valerio Da Ros, Marina Diomedi, Ivan Gallesio, Federica Sepe, Pietro Filauri, Simona Sacco, Guido Squassina, Paolo Invernizzi, Giuseppe Romano, Maria Federica Grasso, Edoardo Puglielli, Alfonsina Casalena, Michele Besana, Alessia Giossi, Alessandro Pedicelli, Giovanni Frisullo, Simone Comelli, Maurizio Melis.

      • Contributors AN: researched literature, study design and conception, clinical data acquisition, data analysis and interpretation, draft of the manuscript. GP: statistical analysis and data interpretation. RC, AB: clinical data acquisition, interpretation and draft of the manuscript. VS study conception and design, clinical data acquisition and draft of the manuscript. MB: study conception and design, data interpretation, critical revision and manuscript supervision; guarantor. SM, DT: critical revision and manuscript supervision. All other authors collected data, reviewed, edited the manuscript, and approved the final version of the manuscript. MB, SM and DT are equally contributing senior authors.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests The author(s) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article. All reported disclosures were outside the submitted work. AZ declares consulting fees from Boehringer-Ingelheim, Alexion and CLS Behring. SS declares personal fees as speaker or advisor: Abbott, Allergan-Abbvie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Pfizer, Teva; research grants: Allergan, Novartis, Uriach; fees for CME/education: Medscape, Neurodiem Ology Medical Education; intellectual: president elect European Stroke Organisation, second vice president of the European Headache Federation, specialty chief editor in Headache and Neurogenic Pain for Frontiers in Neurology, associate editor for The Journal of Headache and Pain, assistant editor for Stroke. No other disclosures were reported.

      • Provenance and peer review Not commissioned; externally peer reviewed.

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