Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke

Abstract

To assess the safety and efficacy of mechanical thrombectomy (MT) with stentretrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC. MATERIALS AND METHODS: The present retrospective study comprised 285 consecutive patients (115 males; mean age 74AE13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score !2b), post-treatment imaging findings. The 90-day clinical outcome was assessed using modified Rankin scale (good outcome defined as 0e2). RESULTS: The following statistically insignificant differences were found in 26 patients on OAC versus 259 patients without OAC: occurrence of symptomatic intracerebral haemorrhage 7.7% versus 8.1%, achievement of successful recanalisation 69.2% versus 82.6%, good 90-day clinical outcome 34.6% versus 56.8%, 90-day mortality 26.9% versus 20.8% (p>0.05 in all cases). Age and neurological deficit at the time of treatment were identified as independent negative predictors of good 90-day clinical outcome (odds ratio [OR]¼0.90, 95% confidence interval [CI]: 0.88e0.94 and OR¼0.83, 95% CI: 0.77e0.90, respectively) and as independent positive predictors of mortality (OR¼1.12, 95% CI: 1.06e1.18 and, OR¼1.17, 95% CI: 1.07e1.27, respectively; p<0.05 in all cases).

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

“…We found that therapeutic anticoagulation in AF patients at the time of stroke did not adversely influence outcome. This finding is similar to several studies, including thrombolysis-ineligible patients [23][24][25][26][27] .…”

Endovascular stroke treatment in orally anticoagulated patients: an analysis from the German Stroke Registry-Endovascular Treatment

“…In general, other published studies [ 2 , 5 , 9 , 16 , 21 , 22 ] and our own data did not support this observation: in our patients, neither VKA nor NOAC intake on admission increased mortality on d90 after MT. These findings on the mortality rate are in accordance with the published ICH rates as a safety parameter that did not seem to be higher among the OAC patients as in our cohort although reported differentially detailed [ 2 , 5 , 9 – 11 , 14 , 16 , 17 , 19 , 21 , 22 ]. Interestingly, the multicenter observational cohort study that had already reported on increased mortality among VKA patients also found increased rates of symptomatic intracranial hemorrhage among these patients which might at least explain the higher mortality rates [ 13 ].…”

“…Our analysis comprises the highest number of patients with 6173 in total and 1306 OAC patients compared to the recently published studies with a total number of patients ranging from 28 to 1913 and a number of OAC patients ranging from 26 to 320 [ 2 , 5 , 9 – 17 , 19 , 21 , 22 ]. Most studies published retrospectively collected data, but four studies were prospective cohort studies [ 2 , 5 , 9 – 17 , 19 , 21 , 22 ]. With regards to technical efficacy of ET, if reported, all studies showed similar reperfusion rates in OAC and non-OAC patients as in our GSR-ET cohort [ 2 , 5 , 9 , 11 , 16 , 19 , 21 , 22 ].…”

“…OAC—variably defined—was even an exclusion criterion in some of them. [ 3 , 4 , 8 , 18 ] Since then, several mostly small retrospective and four prospective observational studies investigated ET in anticoagulated patients [ 2 , 5 , 9 – 17 , 19 , 21 , 22 ]. Because of the overwhelming success of ET, large randomized-controlled trials on this topic are not to be expected in the future due to ethical concerns.…”

The feasibility of dual-energy CT to predict the probability of symptomatic intracerebral haemorrhage after successful mechanical thrombectomy

“…1,2 The recanalisation of large vessels with mechanical thrombectomy (MT) using stent retrievers is an alternative option to intravenous alteplase, which is widely used, especially for selected AIS patients. 3,4 Potential complications of MT, such as intracerebral haemorrhage (ICH) and particularly symptomatic ICH (sICH), need to be taken into consideration. sICH could have severe consequences for the AIS patient and could occur within 24e72 hours after the operation.…”