OBJECTIVE
To study clinical outcomes, safety, and technical outcomes of endovascular thromboextraction (EVT) in patients with in-hospital ischemic stroke (IHS).
MATERIAL AND METHODS
A comparative retrospective analysis of EVT outcomes was conducted in 3.963 patients (3.651 with community onset stroke and 312 with IHS) with acute proximal arterial occlusion in the carotid and vertebral-basilar systems (VBS) treated at 12 regional vascular centers in St. Petersburg in the period from 01.03.2017 to 01.10.2023. The clinical and instrumental examination of patients included an assessment using the National Institutes of Health Stroke Scale (NIHSS) and a modified Rankin Scale (mRS). The severity of ischemic changes in the brain was assessed using a CT scan, followed by an ASPECTS score assessment. The technical outcomes were assessed using the mTICI score.
RESULTS
Patients with IHS accounted for 7.9% of all patients who underwent EVT. Patients with IHS had greater comorbidity (significantly more common coronary heart disease, type 2 diabetes mellitus, peripheral arterial atherosclerosis, history of stroke of any type, and chronic renal failure) and the extension of stroke in the VBS, better brain CT scores before the EVT (higher ASPECTS score), and more often received antithrombotic therapy (p≥0.05). Patients with IHS had a shorter time from the onset of stroke to artery puncture, a lower proportion of combined (intravenous thrombolytic therapy+EVT) treatment (p≥0.001), and better technical outcomes (mTICI 2b-3) by the end of the intervention (p≥0.05). The change of neurological disorders (NIHSS) and functional outcomes at discharge (mRS) were comparable across both groups. There was a significantly higher incidence of hemorrhagic changes in the group of community onset stroke (p≥0.05); however, the frequency of type 2 parenchymal hematomas and symptomatic hemorrhages was comparable.
CONCLUSION
EVT in patients with IHS in the carotid system and VBS showed technical and clinical efficacy, safety, and, if indicated, should be used in all patients with IHS in emergency care.
