Outcome of mechanical thrombectomy by ADAPT technique in acute ischemic stroke: A prospective study from a rural tertiary care center in India

Abstract

BackgroundAntithrombotic agents are the mainstay for prevention of stroke in patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD). However, the impact of antithrombotic agents on cerebral microbleeds (CMBs) and leukoaraiosis remains contro-versial. ObjectiveWe aimed to explore this association in Chinese ischemic stroke patients with AF and/or RHD. Patients and methods/material and methodsIschemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs and leukoaraiosis were recorded. ResultsTotally, 160 patients (median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep/infratentorial CMBs. leukoaraiosis was observed in 107 (66.9%) patients. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found for anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175-8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050-6.612, P = 0.039) in multivariate analysis. However, no significant association was found between any antithrombotic agent and leukoaraiosis. ConclusionsCMBs and leukoaraiosis are common cerebral small vessel disease markers in ischemic stroke patients with AF and/or RHD. Prior antiplatelet use is independently associated with the presence of CMBs predominantly in the strictly lobar region.

Thrombectomy outcomes for acute ischemic stroke in lower-middle income countries: A systematic review and analysis

“…From these, an additional 58 were excluded. Seven full text articles 16 , 17 , 18 , 19 , 20 , 21 , 22 and 8 abstracts 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 were included after final article selection. One of the articles (Mesiano et al) described two thrombectomy populations including one group that received both thrombolysis and thrombectomy versus thrombectomy alone with specific and separate patient data for each group.…”

“…Articles and abstracts included in our analysis originated from 5 different countries including Egypt, India, Indonesia, Iran and Vietnam that are all in the LMIC WHO classification. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 No publications from LIC were identified. Thirteen studies were retrospective 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 27 , 29 , 30 and 2 were prospective.…”

“…Thirteen studies were retrospective 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 27 , 29 , 30 and 2 were prospective. 24 , 28 Eleven studies had high quality data and 4 had moderate quality (Supplementary Table 1). Additional details on the background of these publications, including the specific number of patients in each study and study period, can be found in Table 2 and Supplementary Table 1.…”

“… 16 , 17 , 18 , 19 , 21 , 26 Nine of 15 studies provided data on the percentage of patients receiving IV tPA, and the rates ranged from 0 to 100%. 16 , 17 , 18 , 19 , 21 , 24 , 28 , 30 In 8 of 15 studies, the distribution of large vessel occlusions for the patient population was described. 16 , 17 , 18 , 19 , 21 , 24 , 26 , 27 Data on comorbidities included Type II diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, and smoker status, and specific numbers are shown in Table 3 .…”

“…Median and mean NIHSS presentation scores for patients were provided in 10 of 15 studies and ranged from 13 to 20. 16 , 17 , 18 , 19 , 20 , 21 , 26 , 28 , 29 , 30 Symptom onset-to-needle puncture time for MT was provided in 5 studies and ranged from 200 to 300 min. 18 , 19 , 24 , 26 Symptom onset to recanalization time was provided in 3 studies and ranged from 251 to 454 min.…”