We present one of the first comparison of outcomes looking at mechanical thrombectomy (MT) for in hospital strokes(IHS) versus community-onset strokes(COS).

Most stroke patients have their stroke in the community setting, however a significant minority occur while hospitalized for another condition. Prior studies have noted worse outcomes for IHS compared to COS. The increased use of MT and distinct eligibility criteria from thrombolysis provide additional therapy options

for these patients.

We performed an IRB-approved, retrospective cross-sectional study on patients who underwent MT for acute ischemic stroke between January 2012 and November 2017. Variables reviewed included patient demographics, vascular risk factors, stroke location, symptom onset/recognition time, treatment time, discharge disposition and disability as measured by the Modified Rankin Scale(mRS). Statistical analyses were performed using a logistic regression to assess the relationship between IHS versus COS.

We studied 334 patients(290 COS and 44 IHS) who were treated with MT for acute ischemic stroke. Patients who presented in-hospital were younger(60.7 vs. 70.4years; p<0.001). IHS were more likely to have a history of coronary artery disease(48% vs. 25%; p<0.003) and tobacco use(32% vs. 16%; p<0.032), conversely, they had a lower rate of atrial fibrillation(20% vs. 42% p<0.005). No significant difference was noted in history of diabetes, hypertension, and dyslipidemia. IHS treated with MT had lower use of intravenous thrombolysis(14% vs 34%;p<0.006). Patients with IHS had a significantly shorter mean symptom recognition to femoral stick time(p<0.039). In addition, IHS patients had significantly better outcomes at discharge as measured by mRS 0-3. After

adjustment for age and stroke severity IHS continued to have better outcomes at discharge as measured by mRS 0-3; AOR=4.832; 95% Cl,(1.207-19.348); P< 0.026.

In conclusion, time from symptom recognition to MT is faster for IHS vs. COS. In addition, IHS had less disability after mechanical thrombectomy for large vessel occlusion.