Background:
Endovascular thrombectomy (EVT) is standard of care for patients with large vessel occlusion (LVO) acute ischaemic stroke (AIS). The stroke metrics, stroke detection, stroke mechanisms and outcomes of inpatients with LVO undergoing EVT at our institution are unknown.
Aims:
To investigate the cohort of inpatients who received EVT and delineate time to stroke detection, general stroke metrics, stroke severity, mechanisms and functional outcomes.
Methods:
Inpatients who had EVT from 2018 to 2022 were selected from our stroke registry. Data was extracted from the registry and electronic medical records. Stroke detection was defined as time between stroke onset and code stroke activation. SPSS(R) was used for data analysis.
Results:
A total of 24 patients were included. Nine female (37%) with a mean age of 66 years. The mean Charleston Comorbidtity Index was 4. Median stroke detection time was 25 minutes IQR (8.5 - 47.3) with only 1 case last known well the previous night. Median NIHSS was 19 IQR (14- 24). Two patients were intubated. Stroke codes were called for 14 patients (60%) in the after-hours space. CT perfusion core mean volume was 46±40 ml and the mean penumbral volume was 95±58 ml. Only 2 patients received thrombolysis. The median time from code stroke activation to reperfusion was 149 mins IQR (112-203). Most inpatient strokes were secondary to cardiac embolism (38%). The median pre-stroke modified Rankin score (mRS) was 0. Nine patients (38%) had a mRS 0-2 at 3 months. The 3-month post discharge mRS median was 3 and 3-month mortality was 21%.
Conclusion:
Stroke detection at our institution was highly varied as was the time to reperfusion. These findings are suggestive of medically multimorbid and acutely unstable cohort leading to severe strokes and poorer functional outcomes. Further study in this cohort is required to improve stroke metrics and outcomes.