Acute ischemic stroke in a third trimester of pregnancy – cesarean section followed by mechanical thrombectomy

Wiącek, Marcin; Kaczorowski, Rafał; Oboz-Adaś, Antonina; Kuźniar, Katarzyna; Bartosik-Psujek, Halina

doi:10.1080/00207454.2019.1702539

Cited by 3 publications

(5 citation statements)

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“…There was no mortality or miscarriage during hospitalization after EVT noted [63]. Data from this study and several case reports suggest that MT is safe and efficacious treatment of AIS due to LVO during pregnancy [8,64,65]. This view is reflected by the previously cited Canadian survey on treatment of acute stroke in pregnant and postpartum women.…”

Section: Mechanical Thrombectomysupporting

confidence: 64%

“…In addition, the tremendous progress in neuroimaging procedures, such as introducing of perfusion techniques (computed tomography perfusion, CTP, magnetic resonance perfusion, MRP) and their employment in the treatment qualification process, has created additional diagnostic dif-K ficulty. Some authors highlight that the concern of potential adverse events of imaging and reperfusion therapies can lead to a substantial delay or omission of treatment [8]. It all makes the timely AIS diagnostic and management decisions during pregnancy very challenging.…”

Section: Introductionmentioning

confidence: 99%

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Acute Ischemic Stroke in Pregnancy

et al. 2022

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Introduction Pregnancy increases the risk of acute ischemic stroke (AIS) among young women and is responsible for about 5% of maternal deaths and significant disability. Concerns of potential adverse events of imaging and reperfusion therapies in this group of patients can lead to a substantial delay or omission of treatment that can significantly worsen outcomes. Objective The objective of this study is to discuss main concerns of diagnosis and therapy of pregnant patients with AIS regarding neuroimaging and reperfusion treatment. Results The cumulative radiation dose of computed tomography (CT)-based entire diagnostic procedure (noncontrast CT, CT-angiography and CT-perfusion) is estimated to be below threshold for serious fetal radiation exposure adverse events. Similarly, magnetic resonance imaging(MRI)-based imaging is thought to be safe as long as gadolinium contrast media are avoided. The added risk of intravenous thrombolysis (IVT) and mechanical thrombectomy during pregnancy is thought to be very low. Nevertheless, some additional safety measures should be utilized to reduce the risk of radiation, contrast media and hypotension exposure during diagnostic procedures or reperfusion treatment. Conclusion Fetal safety concerns should not preclude routine diagnostic work-up (except for gadolinium contrast media administration) in childbearing AIS women, including procedures applied in unknown onset and late onset individuals. Due to rather low added risk of serious treatment complications, pregnancy should not be a sole contraindication for neither IVT, nor endovascular treatment.

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Section: Mechanical Thrombectomysupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Acute Ischemic Stroke in Pregnancy

et al. 2022

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“…The remaining 8 patients were treated with a combination of IVT and MT (these subjects have also been taken into consideration for PICO 2.1.). [48][49][50][51][52][53][54][55][56][57][58][59][60] All patients achieved a good outcome according to mRS (mRS 0-2) after 3 months; bleeding complications occurred in two patients only (a small intracerebral haemorrhage in the basal ganglia was observed in one patient receiving MT alone, and a haemorrhagic infarction type 1, that is, petechial haemorrhages at the infarct margins, occurred in one patient treated with bridging therapy); however, both had a favourable outcome. A healthy baby was born to 18 patients; one pregnancy ended in abortion, and in three cases, the birth and child data are missing.…”

Section: Pico 22 In Women With Acute Ischaemic Stroke During Pregnanc...mentioning

confidence: 99%

“…The remaining 8 patients were treated with a combination of IVT and MT (these subjects have also been taken into consideration for PICO 2.1.). 48 – 60 …”

Section: Part 2 Treatment Of Acute Ischaemic Stroke In Pre-menopausal...mentioning

confidence: 99%

European Stroke Organisation guidelines on stroke in women: Management of menopause, pregnancy and postpartum

Kremer

Gdovinová

Béjot

et al. 2022

European Stroke Journal

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Pregnancy, postpartum and menopause are regarded as periods women are more vulnerable to ischaemic events. There are conflicting results regarding stroke risk and hormone replacement therapy (HRT) during menopause. Stroke in pregnancy is generally increasing with serious consequences for mother and child; therefore, recommendations for acute treatment with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) are needed. The aim of this guideline is to support and guide clinicians in treatment decisions in stroke in women. Following the “Grading of Recommendations and Assessment, Development and Evaluation (GRADE)” approach, the guidelines were developed according to the European Stroke Organisation (ESO) Standard Operating Procedure. Systematic reviews and metanalyses were performed. Based on available evidence, recommendations were provided. Where there was a lack of evidence, an expert consensus statement was given. Low quality of evidence was found to suggest against the use of HRT to reduce the risk of stroke (ischaemic and haemorrhagic) in postmenopausal women. No data was available on the outcome of women with stroke when treated with HRT. No sufficient evidence was found to provide recommendations for treatment with IVT or MT during pregnancy, postpartum and menstruation. The majority of members suggested that pregnant women can be treated with IVT after assessing the benefit/risk profile on an individual basis, all members suggested treatment with IVT during postpartum and menstruation. All members suggested treatment with MT during pregnancy. The guidelines highlight the need to identify evidence for stroke prevention and acute treatment in women in more vulnerable periods of their lifetime to generate reliable data for future guidelines.

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“…Radiation dose less than 2.8mGy during interventional procedure was relatively safe for fetus [ 14 ]. Some study [ 15 ] showed that foetal outcome was healthy after MT in the first trimester of pregnancy. Unfortunately, no guidelines for continuation of pregnancy in the first trimester after MT were published at present.…”

Section: Discussionmentioning

confidence: 99%