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Risk profile and treatment options of acute ischemic in-hospital stroke

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Abstract

Despite the potential immediate access to diagnosis and care, in-hospital stroke (IHS) is associated with delay in diagnosis, lower rates of reperfusion treatment, and unfavorable outcome. Endovascular reperfusion therapy has shown promising results in recent trials for community-onset strokes (COS) and is limited by less contraindications than systemic thrombolysis. Thus, endovascular approaches may offer additional acute treatment options for IHS. We performed a retrospective, observational monocentric analysis of patients with acute ischemic stroke between January 2010 and December 2014. Out of 3506 acute ischemic strokes, 331 (9.4 %) were IHS. In-hospital mortality (31.4 vs. 8.0 %) and duration of stay after stroke (19.5 vs. 12.1 days) were higher in IHS than in COS. Most IHS occurred in cardiologic and cardiosurgical patients after catheterization or surgery. In 111 cases (33.5 %) the time of onset could not be established as a result of sedation or delayed referral resulting in delayed symptom recognition. 52 IHS (15.7 %) and 828 COS (26.0 %, p < 0.001) patients received any kind of reperfusion therapy, of which 59.6 % (IHS) and 12.1 % (COS) comprised isolated endovascular interventions (p < 0.001). Intra-hospital delays (time to brain imaging, systemic thrombolysis, and angiography) were longer and outcome parameters (mRS d90, in-hospital mortality, length of stay) were worse in IHS, whereas rates of procedural complications and intracranial hemorrhages were similar in both groups. The overall rate of reperfusion treatment is lower in IHS compared to COS, as IHS patients are less likely to be eligible for systemic thrombolysis. Interventional stroke treatment is a safe and feasible therapeutic option for patients who are not eligible for systemic thrombolysis and should be anticipated whenever IHS is diagnosed.

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Authors and Affiliations

  1. Department of Neurology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Kolja Schürmann, Björn Falkenburger, Simone C. Tauber, Jörg B. Schulz & Arno Reich

  2. Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany

    Omid Nikoubashman & Martin Wiesmann

  3. JARA–Translational Brain Medicine, Jülich and Aachen, Germany

    Jörg B. Schulz

Authors
  1. Kolja Schürmann
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  2. Omid Nikoubashman
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  3. Björn Falkenburger
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  4. Simone C. Tauber
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Correspondence to Arno Reich.

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Conflict of interest

Prof. M. Wiesmann reports grants and personal fees from Stryker Neurovascular, grants and personal fees from SilkRoad Medical, Grants from Covidien, grants from Microvention, grants and personal fees from Bracco, grants and personal fees from Siemens, grants from AB Medica, grants from Acandis, grants from Codman Neurovascular, grants from Penumbra, Grants from Phenox, grants from Abbott, grants from St. Jude, from B. Braun, outside the submitted work. All other authors declare no conflict of interest.

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Schürmann, K., Nikoubashman, O., Falkenburger, B. et al. Risk profile and treatment options of acute ischemic in-hospital stroke. J Neurol 263, 550–557 (2016). https://doi.org/10.1007/s00415-015-8010-2

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  • DOI: https://doi.org/10.1007/s00415-015-8010-2

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