A comparison of in-hospital stroke and community-onset stroke outcomes after endovascular thrombectomy at a tertiary level hospital in Taiwan

Background: While acute-phase thrombectomy is a recognized treatment for main cerebral artery occlusion, variability exists in outcomes for in-hospital stroke and community-onset stroke patients undergoing endovascular thrombectomy. This study investigates the prognostic differences between in-hospital stroke and community-onset stroke patients in an Asian context, with a focus on the impact of patient transfer processes on treatment outcomes. Methods: Data were collected from in-hospital stroke patients who underwent endovascular thrombectomy in a tertiary medical center between January 2017 and December 2020. Propensity score matching with a ratio of 1:4 was performed to compare in-hospital stroke and community-onset stroke patients based on sex, age, NIHSS, and occluded vessel location. Results: The study included 20 in-hospital stroke and 80 community-onset stroke patients, with no significant difference in successful recanalization rates, complications, mortality rates, and NIHSS and mRS scores between the groups. The community-onset stroke group had longer times to treatment, particularly among transferred patients. A high proportion of in-hospital stroke patients had undergone surgery before their stroke, and a greater incidence of heart failure was noted in this group. Conclusion: Despite pre-stroke surgical treatments and a higher rate of heart failure in in-hospital stroke patients, prompt endovascular thrombectomy resulted in comparable outcomes to communityonset stroke patients. The study underscores the importance of reducing treatment times, especially for transferred patients, to improve stroke care efficacy.