Fujita Medical Journal
Online ISSN : 2189-7255
Print ISSN : 2189-7247
ISSN-L : 2189-7247

This article has now been updated. Please use the final version.

Delays in initial workflow cause delayed initiation of mechanical thrombectomy in patients with in-hospital ischemic stroke
Kenichiro SuyamaShoji MatsumotoIchiro NakaharaYoshio SuyamaJun MoriokaAkiko HasebeJun TanabeSadayoshi WatanabeKiyonori KuwaharaYuichi Hirose
Author information
JOURNAL OPEN ACCESS Advance online publication

Article ID: 2021-014


Objectives: The benefit of mechanical thrombectomy for acute ischemic stroke is highly time dependent. However, time to treatment is longer for in-hospital stroke patients than community-onset stroke patients. This study aimed to clarify the cause of this difference.

Methods: A retrospective single-center study was performed to analyze patients with large vessel occlusion who underwent mechanical thrombectomy between January 2017 and December 2019. Patients were divided into in-hospital stroke and community-onset stroke groups. Clinical characteristics and treatment time intervals were compared between groups.

Results: One hundred four patients were analyzed: 17 with in-hospital stroke and 87 with community-onset stroke. Patient characteristics did not significantly differ between groups. Median door (stroke recognition)-to-computed tomography time (36 min vs. 14 min, P<0.01) and door-to-puncture time (135 min vs. 117 min, P=0.02) were significantly longer in the in-hospital stroke group than the community-onset stroke group. However, median computed tomography-to-puncture time (104 min vs. 104 min, P=0.47) and puncture-to-reperfusion time (53 min vs. 38 min, P=0.17) did not significantly differ.

Conclusions: Longer door-to-puncture time in in-hospital stroke patients was mostly caused by longer door-to-computed tomography time, which is the initial part of the workflow. An in-hospital stroke protocol that places importance on early stroke specialist consultation and prompt transportation to the computed tomography scanner might hasten treatment and improve outcomes in patients with in-hospital stroke.

Content from these authors

This is an Open access article distributed under the Terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.