Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory

Guidera, Steven A.; Aggarwal, Sudhir; Walton, Joni; Boland, David M.; Jackel, Roy; Gould, Jeffrey D.; Kearins, Brooke; McGarvey, Joseph F.X.; Qi, Yan; Furlong, Brian

doi:10.1016/j.jcin.2020.01.232

Cited by 23 publications

(15 citation statements)

References 25 publications

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“…We excluded patients if key demographic data was unavailable (age or sex); if the target lesion location was unknown (LVO vs non‐LVO); if baseline National Institutes of Health Stroke Scale (NIHSS) was not available or key post‐procedural outcome data was unavailable (specifically; mortality and modified Rankin score [mRS]). Data included in this study from individual hospitals has been in part, been previously published 13‐15 …”

Section: Methodsmentioning

confidence: 99%

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Outcomes following endovascular therapy for acute stroke by interventional cardiologists

Bob‐Manuel

Hornung

Guidera

et al. 2020

Cathet Cardio Intervent

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Objectives: To summarize the outcomes of acute ischemic stroke (AIS) intervention by interventional cardiologists (IC) working on a stroke team. Background: There is a geographic maldistribution of dedicated neurointerventionalists (NI) to treat large vessel occlusion (LVO) AIS. Methods: Results of 166 consecutive patients who received endovascular therapy (EVT) for AIS due to LVO by IC at three centers between 2009 and 2019 are reported. A modified Rankin score (mRs) of ≤ 2 at 90 days after EVT was used as the primary measurement of a good neurological outcome. Univariate logistic regression was used to evaluate predictors of the mRS > 2 and mortality. Those variables with significance of p < .2 from the univariate analysis were included in a multivariate analysis. Results: All-cause mortality at 30 days was 22%. A favorable clinical outcome, mRS ≤ 2 at 90 days, was 49%. After multivariate analysis and controlling for confounders, a higher baseline NIHSS was predictive of 30-day mortality (OR 1.20 [95% CI 1.09-1.32] p < .001) and unfavorable clinical outcome (mRS > 2) at 90 days (OR 1.16 [95% CI 1.07-1.25] p < .001). Conclusion: Outcomes for carotid stent capable IC performing EVT for AIS are comparable to those achieved by NI physicians in major randomized clinical trials. Our data supports conducting a clinical trial of carotid stent capable IC working on multidisciplinary stroke teams to perform EVT for AIS due to LVO in communities and hospitals without timely access (<60 min by ground transport) to dedicated NI.

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Section: Methodsmentioning

confidence: 99%

“…We performed a retrospective analysis of consecutive patients under- Data included in this study from individual hospitals has been in part, been previously published. [13][14][15]…”

Section: Patient Population and Data Collectionmentioning

confidence: 99%

Outcomes following endovascular therapy for acute stroke by interventional cardiologists

Bob‐Manuel

Hornung

Guidera

et al. 2020

Cathet Cardio Intervent

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“…The American Heart Association/American Stroke Association (AHA/ASA) 2018 guidelines recommend (Class I) mechanical thrombectomy for patients with large vessel occlusions [39] in acute cerebral infarction but most hospitals do not have the capability to perform this procedure. However, if the institution has a cardiac catheterization laboratory, it is possible for interventional cardiologists to work closely with neurologists to perform the mechanical thrombectomy [51]. One study demonstrated restoration of blood flow in 80% of patients who underwent mechanical thrombectomy by interventional cardiologists for acute cerebral infarction [51].…”

Section: Treatment Considerationsmentioning

confidence: 99%

“…However, if the institution has a cardiac catheterization laboratory, it is possible for interventional cardiologists to work closely with neurologists to perform the mechanical thrombectomy [51]. One study demonstrated restoration of blood flow in 80% of patients who underwent mechanical thrombectomy by interventional cardiologists for acute cerebral infarction [51]. This may be a setting of opportunity for neurologists and cardiologists to explore a team effort in a cardiac catheterization laboratory to perform a mechanical thrombectomy and PCI for CCI.…”

Section: Treatment Considerationsmentioning

confidence: 99%

A Case Report on Concurrent Stroke and Myocardial Infarction

Khairy

Ranasinghe³

et al. 2021

Asp Biomed Clin Case Rep

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Concurrent myocardial infarction and acute cerebral infarction is a rare and poorly studied phenomenon that presents a challenge to treat as both conditions are life threatening with narrow therapeutic windows. We present the case of a 70 year old female who presented with symptoms concerning for stroke. However, an electrocardiogram revealed she was also having an acute myocardial infarction. The decision was made to treat the stroke with intravenous tissue plasminogen activator. Unfortunately, the patient ultimately decompensated and died. There are many proposed etiologies of this phenomenon including cardiac thrombi leading to concurrent acute myocardial infarction and cerebral infarction, a primary myocardial infarction leading to a cerebral infarction, and a primary cerebral infarction leading to an acute myocardial infarction. Treatment options include simultaneous mechanical thrombectomy and percutaneous coronary intervention in a cardiac catheterization laboratory, or treating with the intravenous tissue plasminogen activator dose for a cerebral infarction and then potentially also proceeding to percutaneous coronary intervention. Ultimately, the management of this situation will depend on the patient’s specific situation including the type of stroke, the extent of irreversible tissue damage, and the hospital’s available resources. A randomized controlled study is difficult because of the rare occurrence of both presentations and a systematic review of the available literature may provide physicians with better insight as to how to approach a simultaneous acute myocardial infarction and acute cerebral infarction.

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“…Небольшие проспективные регистровые исследования показали, что клинические исходы у пациентов после тромбоэкстракции, выполненной в отделениях кардиологического профиля, могут быть не хуже, чем в специализированных нейроинтервенционных центрах [23,24]. Недостаток фундаментальных неврологических знаний у интервенционных кардиологов решался привлечением мультидисциплинарной команды, которая включала невролога и врача лучевой диагностики.…”

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Endovascular treatment results in patients with large cerebral artery occlusions in a metropolis. Moscow Stroke Registry data over 2019

Скрыпник

Anisimov

Botsina

et al. 2020

RJTAO

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Objective: to assess results from the Stroke Network created on the basis of the Infarction Network in the metropolis Moscow for endovascular treatment in patients with occlusion of the large cerebral artery (the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, and the main artery).Patients and methods. A total of 742 thromboextractions were performed in patients with ischemic stroke in Moscow Stroke Network hospitals in 2019. The final analysis included 729 patients aged 25 to 97 years (mean age, 71 years); of them there were 370 (50.8%) men and 359 (49.2%) women. The selection criteria for endovascular treatment for ischemic stroke were consistent with those set out in the 2015 American Heart Association/American Stroke Association (AHA/ASA) guidelines, which included a pre-stroke modified Rankin Scale (MRS) score of 0–1; ≥18 years of age; a National Institutes of Health Stroke Scale (NIHSS) score of ≥6; and an Alberta Stroke Programme Early CT score (ASPECTS) ≥6. The angiographic results were assessed using the Thrombolysis in Cerebral Infarction (TICI) scale. The clinical outcomes were measured with the NIHSS and the MRS.Results and discussion. Successful recanalization (TICI 2b/3) was achieved in 547 (75%) patients. The predominant technique for thromboextraction was thromboaspiration that was used in 376 (51.6%) patients. Combined procedures (the co-use of an aspiration catheter and a stent retriever) were the second most commonly used – in 231 (31.7%) patients. By the end of the 20th day, good functional recovery (MSR 0–2 scores) was observed in 213 (29.2%) patients. The 20-day mortality rate was 31.8%.Conclusion. The successfully functioning Infarction Network in Moscow was used to create the Stroke Network for treatment in patients with ischemic stroke and large cerebral artery occlusion, the clinical results of which are comparable to large European registry studies.

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Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory

Cited by 23 publications

References 25 publications

Outcomes following endovascular therapy for acute stroke by interventional cardiologists

Outcomes following endovascular therapy for acute stroke by interventional cardiologists

A Case Report on Concurrent Stroke and Myocardial Infarction

Endovascular treatment results in patients with large cerebral artery occlusions in a metropolis. Moscow Stroke Registry data over 2019

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