Catheter-Based Treatment for Patients With Acute Ischemic Stroke Ineligible for Intravenous Thrombolysis

Abstract

Background and Purpose-We present our single-center experience using catheter-based therapy for acute ischemic stroke patients who were not candidates for intravenous thrombolytic therapy. Methods-Neurologic outcomes were assessed in patients with acute ischemic stroke, ineligible for intravenous thrombolysis, treated with an emergent catheter-based therapy. Results-Nonparametric analysis of neurological outcomes demonstrated a benefit in National Institutes of Health Stroke Scale (NIHSS) at long-term follow-up (Pϭ0.036). Independence in daily activities and improvement in NIHSS of Ն4 points were achieved in 38% and 56% of patients, respectively. Four patients (25%) died, including 2 patients (12.5%) who died from intracranial hemorrhage. Conclusions-Catheter-based treatment offers a promising treatment strategy in patients with acute ischemic stroke ineligible for intravenous thrombolysis.

Acute stroke intervention by interventional cardiologists

“…Our data demonstrate the safety and efficacy of CBT in the hands of interventional cardiologists with carotid stent experience (in conjunction with stroke neurologists) for patients with acute stroke who are not eligible for intravenous thrombolysis. When combining this cohort of patients with our previously published data [20], our outcomes are very much in line with published trials (Table VI).…”

“…We combined the outcomes of the present cohort with our previously published series of 16 CBT stroke patients [20]. The combined group of 42 patients demonstrates favorable outcomes for functional status, morbidity, and mortality when compared with previously published trials (Table VI).…”

“…At our center, CBT is performed by interventional cardiologists with extensive carotid stenting experience who provide ondemand, 24 hr a day, year-round coverage for intracranial CBT [20]. The use of intracranial angioplasty and stenting for acute stroke has been reported in case series with recanalization rates that approach 90% [25][26][27].…”

“…Bleeding into the brain (ICH) is more strongly associated with death [39] than intramyocardial hemorrhage. ICH is not rare following CBT, with symptomatic ICH rates of 3-12% across published trials [4,13,20,24,27]. Mortality at 3 months is markedly higher for stroke patients (17-32%) [4,13] than the single digit mortality seen following hospital discharge for heart attack patients [40].…”

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous+Intra-Arterial Thrombolysis

“…Monte Carlo methods were used to generate simulated data that had the same means and distributions as the resulting pooled data. 34 Analyses of variance followed by post hoc analysis with Scheffe adjustment was done to compare outcomes in the simulated data for each treatment. 35 Metaregression was used to test the influence of treatment type, year of subject recruitment, baseline NIHSS, time to treatment initiation, and other baseline covariates on outcome.…”