Recommendations for Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Papanagiotou, Panagiotis; Ntaios, George; Papavasileiou, Vasileios; Psychogios, Klearchos; Psychogios, Marios; Mpotsaris, Anastasios; Rizos, Timolaos; Spengos, Konstantinos; Gravanis, Miltiadis; Vassilopoulou, Sofia; Gkogkas, Christos G.; Zampakis, Petros; Zis, Panagiotis; Karantanas, Apostolos H.; Karygiannis, Michail; Karydas, Georgios; Korompoki, Eleni; Makaritsis, Konstantinos; Marmagkiolis, Konstantinos; Milionis, H. J.; Mitsikostas, Dimos D.; Nikas, Dimitrios; Plomaritoglou, Androniki; Politi, Maria; Ptochis, Nikolaos; Savopoulos, Christos; Takis, Konstantinos; Tsamopoulos, Nikolaos; Tsetis, Dimitrios; Hatzidakis, Adam; Chatziioannou, Achilleas; Hatzitolios, Apostolos; Vemmos, Konstantinos

doi:10.1007/s00062-017-0645-1

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…To evaluate the quality of the existing evidence and build the recommendations we used the grading system of the American College of Chest Physicians 5 which had been previously used in other HSO clinical recommendations. [6][7][8] This system classifies recommendations as strong (Grade 1) or weak (Grade 2), based on the possible benefits, risks, burdens, and cost. Additionally, the quality of evidence was classified as high (Level A), moderate (Level B), or low (Level C) according to the study design, the consistency of the results, and the directness of the evidence (Table 1).…”

Section: Quality Of Evidencementioning

confidence: 99%

“…If a patient develops statin-related adverse effects, another statin regimen (lower dose of the same statin or another statin or alternate statin administration) should be used. If the adverse effects recur following change of statin regimen, statin therapy should be permanently discontinued and International Journal of Stroke, 16 (6) ezetimibe and/or a PCSK9 inhibitor should be prescribed (2C).…”

Section: Recommendationsmentioning

confidence: 99%

“…63 HBV: hepatitis B virus; HCV: hepatitis C virus; NAFLD: nonalcoholic liver disease; AIH: autoimmune hepatitis; PBC: primary biliary cholangitis; LT: liver function tests. International Journal of Stroke, 16 (6) The association between very low LDL levels and the risk of ICH seems weak. This putative small risk of ICH does not seem adequate to outweigh the CV benefits of lipidmodification treatment (2B) Previous data from the SPARCL study suggested a small but significant correlation of intense statin treatment to hemorrhagic stroke (HR: 1.66; 95% CI: 1.08-2.55), which was driven especially from patients with lacunar stroke as inclusion event.…”

Section: Recommendationsmentioning

confidence: 99%

“…1: The recommendation is powerful as the benefit of the selection clearly outweighs the risk (or vice versa) 2: The recommendation is weak as it is not clear if the benefit of the selection outweighs the risk International Journal of Stroke, 16(6) …”

mentioning

confidence: 99%

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Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Sagris

Ntaios

Georgiopoulos

et al. 2020

International Journal of Stroke

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Section: Quality Of Evidencementioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Sagris

Ntaios

Georgiopoulos

et al. 2020

International Journal of Stroke

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Scoping Review of Clinical Practice Guidelines for the Early Management of Stroke with Focus on Endovascular Treatment

et al. 2021

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Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke

Meyer

Alexandrou

Flottmann

et al. 2020

JAHA

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Background Patients aged ≥90 were excluded or under‐represented in past thrombectomy trials; thus, uncertainty remains whether treatment benefits can be expected regardless of age. This study investigates outcome and safety of thrombectomy in nonagenarians to improve decision making in a real‐world setting. Methods and Results All currently available data of patients aged ≥90 enrolled in the GSR‐ET (German Stroke Registry–Endovascular Treatment) were combined with a smaller cohort from 3 tertiary stroke centers. Baseline characteristics, procedural (Thrombolysis in Cerebral Infarction scale) and functional outcomes (modified Rankin Scale; mRS ), as well as complications (symptomatic intracranial hemorrhage, serious adverse events; SAEs) were analyzed. Good functional outcome was defined as mRS ≤3 at 90‐days. 203 patients with anterior circulation stroke and prestroke mRS ≤3 were included. The rate of successful recanalization (Thrombolysis in Cerebral Infarction scale ≥2b) was 75.9% (154/203). Good functional outcome ( mRS ≤3) was observed in 21.6% (41 of 193) at 90‐days. In‐hospital mortality was 27.1% (55 of 203) and increased significantly at 90 days to 48.9% (93 of 190; P <0.001). Symptomatic intracranial hemorrhage occurred in 3% (6 of 203) of patients. Logistic regression analysis identified Alberta Stroke Program Early CT Score (adjusted odds ratio, 1.93; 95% CI , 1.01–3.70; P =0.046) and initial National Institute of Health Stroke Scale (adjusted odds ratio, 0.85; 95% CI , 0.76–0.97; P =0.014) as independent predictors for good outcome. Patients with successful recanalization had a significant ( P =0.001) shift of mRS distribution with higher rates of good functional outcomes (23.8% [34 of 143] versus 14.9% [7 of 47]) and lower mortality at 90‐days (46.8% [67 of 143] versus 55.3% [26 of 47]). Conclusions Despite high mortality and less frequent favorable outcome, our data suggest that thrombectomy is still effective and safe for nonagenarians. Decision making for thrombectomy in patients aged ≥90 should be based on a case‐by‐case basis with regard to initial National Institute of Health Stroke Scale and Alberta Stroke Program Early CT Score.

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Recommendations for Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Abstract: This document presents the consensus recommendations of the Hellenic Stroke Organization which can be of assistance to the treating stroke physicians.

Cited by 3 publications

References 28 publications

Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Scoping Review of Clinical Practice Guidelines for the Early Management of Stroke with Focus on Endovascular Treatment

Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke

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