Comparison of clinical outcomes of reperfusion therapies in in-hospital and community-onset acute ischemic stroke: A retrospective cohort study.

In-hospital acute ischemic stroke (AIS) is a distinct clinical entity that may differ from community-onset AIS in terms of patient characteristics, treatment processes, and outcomes. This study aimed to compare the clinical features, treatment pathways, and functional outcomes of patients with in-hospital versus community-onset AIS who received recanalization therapies. This retrospective analysis included adult patients with AIS treated with intravenous tissue plasminogen activator and/or mechanical thrombectomy (MT) at a single center between July 2020 and January 2025. The patients were stratified based on whether stroke occurred during hospitalization or in the community. Patient demographics, treatment strategies, procedural time intervals, recanalization success, and clinical outcomes were assessed. The in-hospital stroke group had a higher prevalence of cardiac disease and malignancy. The patients in this group underwent groin puncture sooner after symptom onset, and all those who underwent MT achieved successful recanalization. Nevertheless, the rates of favorable functional recovery at 3 months (modified rankin scale ≤ 2) and in-hospital mortality were similar between the in-hospital and community-onset stroke groups. In-hospital stroke was not identified as a significant predictor of 3-month functional outcome in the multivariate analysis. Among patients who received recanalization therapies, in-hospital AIS cases (despite a higher comorbidity burden) can achieve clinical outcomes similar to those of community-onset strokes through early recognition and treatment initiation. These findings highlight the importance of structured in-hospital stroke protocols and the role of MT in in-hospital stroke management.