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Conference Paper: Mechanical thrombectomy for in-hospital versus community-onset ischemic stroke: comparison of time metrics, technical and clinical outcomes
Title | Mechanical thrombectomy for in-hospital versus community-onset ischemic stroke: comparison of time metrics, technical and clinical outcomes |
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Authors | |
Issue Date | 2021 |
Publisher | The Hong Kong Neurosurgical Society. |
Citation | 28th Annual Scientific Meeting of The Hong Kong Neurosurgical Society: Updates on Traumatic Brain Injury and Neurocritical Care, Virtual Meeting, Hong Kong, 26-27 November 2021 How to Cite? |
Abstract | Objective: Intra-arterial thrombectomy (IAT) for in-hospital onset ischemic stroke with large vessel occlusion (LVO) is not uncommon. In-patient delay to timely neuroimaging and intervention is a reported phenomenon, but no local study on this specific issue is available. We aimed to analyze the technical and clinical outcomes of in-hospital stroke (IHS) patients with IAT performed, compared to the community-onset group (COS).
Method: A retrospective 5-year data analysis was performed for 240 consecutive IATs done at Queen Mary Hospital from January 2016 to June 2021. They were dichotomized into the in-hospital and community-onset subgroups. Independent variables, such as baseline demographics, presenting NIHSS, ASPECTS, location of occlusion and thrombectomy device used, were collected. Primary outcome was functional independence (mRS 0-2) at 3 months. Secondary outcomes included onset-to-puncture time, CT-to-CTA (angiogram) time, onset-to-perfusion time, rates of successful reperfusion (TICI 2b/3), significant intracerebral hemorrhage (sICH) and 6-month mortality. These outcomes were compared with the COS cohort.
Result: Among the IATs performed, 21% (50/240) were for in-hospital stroke. 38% (19/50) occurred peri-procedurally (within 14 days post-intervention). The rate of intravenous tissue plasminogen activator (IV-tPA) administration was lower (22% vs 48%, P<0.001) in the IHS group. The mean onset-to-puncture (297 vs 247 min, P=0.041) and onset-reperfusion time (379 vs 314 min, P=0.009) were significantly longer in the IHS group. The 3-month mRS 0-2 rate (40% vs 41%, P=0.91), successful reperfusion rate (84% vs 86%, P=0.85), 6-month mortality (31% vs 27%, P=0.71) and sICH (2% vs 5%, P=0.69) were similar.
Conclusion:There were significant time latencies in the management of in-hospital onset LVOs. This may represent missed opportunities in the management of hyperacute stroke. Pre-specified pathways and revolutions in workflow sequence are needed to close the gap with community-onset LVOs. |
Description | Oral Presentation - Free Paper VII - Vascular |
Persistent Identifier | http://hdl.handle.net/10722/308986 |
DC Field | Value | Language |
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dc.contributor.author | Sum, CHF | - |
dc.contributor.author | Tsang, COA | - |
dc.contributor.author | Ho, WWS | - |
dc.contributor.author | Lui, WM | - |
dc.date.accessioned | 2021-12-14T01:39:04Z | - |
dc.date.available | 2021-12-14T01:39:04Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | 28th Annual Scientific Meeting of The Hong Kong Neurosurgical Society: Updates on Traumatic Brain Injury and Neurocritical Care, Virtual Meeting, Hong Kong, 26-27 November 2021 | - |
dc.identifier.uri | http://hdl.handle.net/10722/308986 | - |
dc.description | Oral Presentation - Free Paper VII - Vascular | - |
dc.description.abstract | Objective: Intra-arterial thrombectomy (IAT) for in-hospital onset ischemic stroke with large vessel occlusion (LVO) is not uncommon. In-patient delay to timely neuroimaging and intervention is a reported phenomenon, but no local study on this specific issue is available. We aimed to analyze the technical and clinical outcomes of in-hospital stroke (IHS) patients with IAT performed, compared to the community-onset group (COS). Method: A retrospective 5-year data analysis was performed for 240 consecutive IATs done at Queen Mary Hospital from January 2016 to June 2021. They were dichotomized into the in-hospital and community-onset subgroups. Independent variables, such as baseline demographics, presenting NIHSS, ASPECTS, location of occlusion and thrombectomy device used, were collected. Primary outcome was functional independence (mRS 0-2) at 3 months. Secondary outcomes included onset-to-puncture time, CT-to-CTA (angiogram) time, onset-to-perfusion time, rates of successful reperfusion (TICI 2b/3), significant intracerebral hemorrhage (sICH) and 6-month mortality. These outcomes were compared with the COS cohort. Result: Among the IATs performed, 21% (50/240) were for in-hospital stroke. 38% (19/50) occurred peri-procedurally (within 14 days post-intervention). The rate of intravenous tissue plasminogen activator (IV-tPA) administration was lower (22% vs 48%, P<0.001) in the IHS group. The mean onset-to-puncture (297 vs 247 min, P=0.041) and onset-reperfusion time (379 vs 314 min, P=0.009) were significantly longer in the IHS group. The 3-month mRS 0-2 rate (40% vs 41%, P=0.91), successful reperfusion rate (84% vs 86%, P=0.85), 6-month mortality (31% vs 27%, P=0.71) and sICH (2% vs 5%, P=0.69) were similar. Conclusion:There were significant time latencies in the management of in-hospital onset LVOs. This may represent missed opportunities in the management of hyperacute stroke. Pre-specified pathways and revolutions in workflow sequence are needed to close the gap with community-onset LVOs. | - |
dc.language | eng | - |
dc.publisher | The Hong Kong Neurosurgical Society. | - |
dc.relation.ispartof | The Hong Kong Neurosurgical Society 28th Annual Scientific Meeting (Virtual), 2021 | - |
dc.title | Mechanical thrombectomy for in-hospital versus community-onset ischemic stroke: comparison of time metrics, technical and clinical outcomes | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Tsang, COA: acotsang@hku.hk | - |
dc.identifier.email | Ho, WWS: howsw@hku.hk | - |
dc.identifier.authority | Tsang, COA=rp01519 | - |
dc.identifier.hkuros | 331061 | - |
dc.publisher.place | Hong Kong | - |