Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Abstract

BackgroundThe purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis.MethodsWe performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence.ResultsMT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.

Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura

“…Por otra parte, la evidencia demuestra que los pacientes procedentes de áreas no urbanas tuvieron peores resultados neurológicos que los pacientes de áreas urbanas, donde el centro receptor pudo realizar trombectomía 55 . Además, también hubo beneficio en pacientes ≥ 80 años 57 y en pacientes con discapacidad preexistente 58 tanto en modified rankin scale como en mortalidad. Así pues, el coste/beneficio puede variar significativamente según los factores clínicos y geográficos 59 , 60 .…”

Transbrachial Mechanical Thrombectomy for Acute Ischemic Stroke in Marfan’s Syndrome: A Case Report

“…Acute ischemic stroke (AIS) is rare in MFS, and major guidelines about the safety and efficacy of endovascular treatment are not presented. 1) In some studies in the literature, thrombolytic therapy with tissue plasminogen activator (tPA) or mechanical thrombectomy (MT) for AIS associated with MFS has been reported [2][3][4][5] ; however, the safety and efficacy have not been well known.…”

Mechanical Thrombectomy for Septic Embolism Secondary to Staphylococcus lugdunensis Bacteremia without Infective Endocarditis: A Case Report

“…1 In patients with active IE who are found to have emergent large vessel occlusions (ELVO), the Society recommends that mechanical thrombectomy (MT) be considered as the risks and benefits are similar compared to MT in patients without IE. 2 IE due to Staphylococcus lugdunensis (S. lugdunensis) is associated with a high mortality rate, especially in patients who are only treated medically. 3,4 We report here on a case of successful MT for ELVO due to an S. lugdunensis septic embolism in a patient with bacteremia in the absence of endocarditis.…”

“…Ischemic stroke occurs in an estimated 40% of patients with infective endocarditis (IE) and is associated with a higher morbidity and mortality [ 1 ]. In patients with active IE who are found to have emergent large vessel occlusions (ELVO), the Society recommends that mechanical thrombectomy (MT) be considered as the risks and benefits are similar compared to MT in patients without IE [ 2 ]. IE due to Staphylococcus lugdunensis ( S. lugdunensis ) is associated with a high mortality rate, especially in patients who are only treated medically [ 3 , 4 ].…”