Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system

Aaron, Sanjith; Shyamkumar, NK; Alexander, Sunithi; Babu, P Suresh; Prabhakar, Appaswamy Thirumal; Moses, Vinu; Murthy, T V; Alexander, Mathew

doi:10.4103/0972-2327.173302

Cited by 38 publications

(19 citation statements)

References 17 publications

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“…Aaron et al described two cases of MCA occlusion treated with endovascular thrombectomy only through aspiration by the Penumbra system. 20 Bhogal et al reported a case of MCA occlusion treated by stent retriever thrombectomy and a basilar artery occlusion treated by combined reperfusion therapy. 14 The outcome was good for both the mothers and children in these four cases, emphasizing the benefit of this treatment approach in this specific population.…”

Section: Discussionmentioning

confidence: 99%

Combined reperfusion therapy to treat cryptogenic acute ischemic stroke during the first trimester of pregnancy: case report and literature review

Zhu¹,

Gory²,

Mione³

et al. 2018

TCRM

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Cerebral infarction due to acute embolism in the large artery during pregnancy is a rare but severe condition threatening both the mother’s and child’s life. Physicians lack diagnostic and therapeutic guidance to manage this particular situation due to the paucity of published cases. Furthermore, the pathogeny is poorly known, rendering preventive strategies difficult. We describe the case of a young woman presenting cryptogenic acute cerebral infarction during the first trimester of pregnancy who was successfully treated with combined reperfusion therapy. We reviewed the literature to collect data about pathogeny and management. A 28-year-old pregnant woman was diagnosed with acute cerebral infarction due to left middle cerebral artery occlusion at 9 weeks of gestation. Endovascular thrombectomy combined with intravenous thrombolysis allowed cerebral reperfusion leading to a decrease in the National Institute of Health Stroke Score from 13 to 1 at 24 hours. Comprehensive etiological investigation was negative. Anticoagulation therapy with low-molecular-weight heparin was administered as preventive treatment during the pregnancy and postpartum. Neither the mother nor the child experienced any complications: the baby was born by normal vaginal delivery and the outcome was good at 1 year. We identified 21 other cases of patients treated with reperfusion therapies, four of which consisted of endovascular thrombectomy, and only one a combined strategy. Pregnant women with acute cerebral infarction due to arterial occlusion can benefit from combined reperfusion therapy. More cases should be collected to assess treatment in these patients, to understand pathogeny, and propose the best preventive strategy.

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Section: Discussionmentioning

confidence: 99%

Combined reperfusion therapy to treat cryptogenic acute ischemic stroke during the first trimester of pregnancy: case report and literature review

Zhu¹,

Gory²,

Mione³

et al. 2018

TCRM

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“…To date only 2 cases of mechanical thrombectomy for thromboembolic stroke have been published [20]. Aaron et al [20] recently published 2 cases of women, both of whom were in their 20s and in the 3rd trimester.…”

Section: Discussionmentioning

confidence: 99%

“…Aaron et al [20] recently published 2 cases of women, both of whom were in their 20s and in the 3rd trimester. One patient had undergone a previous mitral valve replacement, and her normal oral anticoagulants had been switched to low-molecular-weight heparin.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy in Pregnancy: Report of 2 Cases and Review of the Literature

Bhogal¹,

Aguilar²,

AlMatter³

et al. 2017

Intervent Neurol

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Background: Mechanical thrombectomy has recently proved extremely effective in improving the outcome of patients with large vessel occlusion. Despite this, questions still remain over certain cohorts of patients that were excluded from the large randomised controlled trials. One such cohort includes pregnant patients. Although thromboembolic stroke is uncommon in pregnancy, the outcome from this pathology can be devastating. Summary: We present 2 cases of mechanical thrombectomy in pregnancy both of which underwent successful flow restoration without complications. We discuss the incidence of stroke in pregnancy, potential pitfalls of imaging, radiation protection issues, and the role of thrombolysis as well as the available literature on mechanical thrombectomy in this cohort. Key Message: Thrombectomy in pregnancy can be performed safely with no significant changes required to the procedure itself. Radiation exposure during the procedure should be minimised and shielding used to prevent scatter radiation to the fetus; however, given the potential risks of thrombolysis in this cohort of patients, mechanical thrombectomy should be considered in all stages of pregnancy.

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“…The benefit of systemic thrombolysis with tissue plasminogen activator as well as endovascular therapy in acute ischemic stroke is well documented [1]. Furthermore, recent studies have documented that thrombolysis followed by thrombectomy using a stent retriever in patients with acute ischemic stroke in the proximal anterior intracranial circulation is superior to thrombolysis alone [2].…”

Section: Introductionmentioning

confidence: 99%

“…However, to date, pregnant women with acute ischemic stroke have been excluded from reperfusion trials, resulting in paucity of evidence within this area [5]. The concerns regarding the use of thrombolysis during pregnancy include the risk of placental abruption, retroplacental hemorrhage, abortion, peripartum uterine bleeding and postpartum hemorrhage, as well as possible teratogenicity of thrombolysis treatment [1, 6, 7]. The use of thrombectomy during pregnancy raises concerns regarding radiation, anesthesia related complications, and the use of contrast during the procedure [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy

E¹,

H²,

Modrau³

et al. 2019

Case Rep Neurol

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Pregnancy has usually been an exclusion criterion in clinical trials with thrombolysis and endovascular therapy in acute ischemic stroke. For that reason, these therapies are not recommended causing lack of evidence and vice versa. In this case report, we describe a pregnant woman in week 33 + 3 presenting with acute ischemic stroke, which was successfully treated with systemic thrombolysis and endovascular therapy, resulting in a good clinical outcome for both mother and child. The altered fibrinolytic system and the risk factors related to pregnancy constitute a challenge for clinicians when choosing the most suitable treatment modality for treating acute ischemic stroke in pregnancy. It is still uncertain whether thrombolysis in combination with endovascular therapy or endovascular therapy alone is the most appropriate treatment option. However, there is slowly growing evidence that thrombolysis and thrombectomy in pregnancy are feasible and safe with a good clinical outcome for both the mother and the child.

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Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system

Cited by 38 publications

References 17 publications

Combined reperfusion therapy to treat cryptogenic acute ischemic stroke during the first trimester of pregnancy: case report and literature review

Combined reperfusion therapy to treat cryptogenic acute ischemic stroke during the first trimester of pregnancy: case report and literature review

Mechanical Thrombectomy in Pregnancy: Report of 2 Cases and Review of the Literature

Acute Ischemic Stroke in Late Pregnancy Treated with Intravenous Thrombolysis and Endovascular Therapy

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