Background/Aim: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis. Methods: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic stroke patients undergoing mechanical thrombectomy from January 2008 to June 2017. Patients receiving any dose of intravenous or intra-arterial thrombolysis were excluded. Patients taking oral anticoagulants (VKAs or DOACs) were compared with non-anticoagulated patients. Outcomes compared between groups included the rate of intracerebral haemorrhage (ICH) on follow-up imaging (ICHany), symptomatic ICH, functional independence at 90 days (modified Rankin scale score, 0–2), mortality, and post-treatment recanalization (Thrombolysis in Cerebral Infarction score ≥2b). Results: In all, 102 patients undergoing mechanical thrombectomy without prior thrombolysis were included in the study. Sixty-six (64.7%) patients were not anticoagulated, 23 (22.5%) patients were taking VKAs, and 13 (12.7%) patients were taking DOACs. There were no significant differences in the rate of ICHany (11.1 vs. 13.6%, p = 0.93) or sICH (2.8 vs. 1.5%, p = 0.14) in anticoagulated patients compared to non-anticoagulated patients. No cases of sICH were observed among patients taking DOACs. After 90 days of follow-up, the rates of functional independence (50.0 vs. 43.1%) and mortality (27.8 vs. 25.8%) were also similar between the anticoagulation and the non-anticoagulation groups. Conclusion: Mechanical thrombectomy appears to be safe and effective in anticoagulated patients ineligible for thrombolysis, with observed haemorrhage rates similar to those of patients not on anticoagulant therapy. However, further multicentre prospective studies are needed, due to the rising number of patients on warfarin and DOACs worldwide.
Introduction/PurposeWe evaluated recanalization times with the Solitaire device in patients undergoing endovascular acute ischemic stroke therapy at our institution.Materials and MethodsWe reviewed patients who presented to our stroke center and in whom a Solitaire device was used for revascularization. Demographic data and stroke severity were obtained from chart review. Time points for CT scanning, angiography arrival, puncture, time of first deployment of the device and recanalization times were recorded from time-stamped PACS images and angiography records. Time intervals were calculated (CT to angiography arrival, angiography arrival to puncture, puncture to first deployment and deployment to recanalization). To evaluate time interval trends, recanalized patients were sequentially divided into three sequential groups. Overall CT to recanalization time and interval times between groups were compared using an analysis-of-variance (ANOVA) test. In addition, we also looked for difference between groups using the Scheffe's test correcting for multiple comparisons. All tests are two sided with a p value <0.05 considered to be statistically significant. Analysis was performed using Stata® V.12.Results83 patients (38 female; mean age: 65.7±14.3) were treated with the Solitaire device from May 2009 to February 2012. The median NIHSS was 17. Recanalization (TIMI 2/3) occurred in 75 (90.4%) patients. CT to recanalization time showed a statistically significant decrease over time (p<0.01). This difference was maximal between first 25 and most recent 25 cases (161 to 94 min, p<0.01). The maximal contribution to this was from improvements in first deployment to recanalization time between the first 25 and second 25 patients (p=0.01) and between the first and third 25 patients (p=0.001) with modest contributions from moving patients from CT to the angiography-suite faster (p=0.02 between 1st and 3rd groups) and from puncture to first deployment (p=0.02 between 1st and 3rd groups). There was no statistically significant difference in time from angiography-suite arrival to puncture between the groups (Abstract P-031 figure 1).Abstract P-031 Figure 1ConclusionThere appears to be a learning curve involved in the efficient use of the Solitaire device in endovascular acute stroke therapy. Along with slight improvements in moving patients to angiography sooner and improved efficiency with intracranial access, mastering this device contributed significantly toward the overall drive to reduce recanalization times in stroke patients treated by an endovascular approach at our institution. This needs to be validated in a prospective manner to understand components of this learning curve that is potentially useful to educate new users to achieve faster recanalization times.Competing interestsNone.
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