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Long-term safety and effectiveness of inferior vena cava filters in patients with stroke
  1. Bhanusupriya Somarouthu1,
  2. Kalpana Yeddula1,
  3. Stephan Wicky1,2,
  4. Joshua A Hirsch1,2,3,
  5. Sanjeeva P Kalva1,2
  1. 1Division of Vascular Imaging and Intervention, Department of Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Division of Neuro Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Sanjeeva P Kalva, GRB-297 Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; skalva{at}partners.org

Abstract

Purpose To assess the long-term safety and clinical effectiveness of inferior vena cava (IVC) filters in patients with stroke.

Method and materials In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, we reviewed the clinical data of patients who had stroke and were treated with an IVC filter from 2002 to 2009. The demographics, clinical data, indications for IVC filter, procedural complications, symptomatic post-filter pulmonary embolism (PE) and deep vein thrombosis (DVT), caval occlusion and incidental, imaging-evident filter-related complications were recorded. Safety was assessed through occurrence of filter-related complications during placement and follow-up. Effectiveness was assessed through occurrence of post-filter fatal and non-fatal PE.

Results During this period, 371 patients (224 male; mean age 67.5 years) with stroke received an IVC filter. The stroke was hemorrhagic in 28%, ischemic in 20%, associated with intracranial malignancy in 21% and trauma in 31%. 235 (63%) patients (PE in 159) had venous thromboembolism on imaging. The indications for IVC filter included contraindication to anticoagulation in 251 (68%), prophylaxis in 83 (22%), added protection in 22 (6%) and complication or failure of anticoagulation in 15 (4%). There was one procedural complication. During a follow-up of 1.74±2.36 years, 180 (49%) patients died, three due to post-filter PE and the remainder all due to primary disease. Symptomatic post-filter PE and DVT occurred at a frequency of 15% (54/371) and 16% (60/371), respectively. Of these, 15 (4%) had imaging-proven PE. Three (0.8%) succumbed to post-filter PE. Imaging-proven new or recurrent DVT occurred in 6% and 8%, respectively. Symptomatic caval occlusion was seen in five (5/371, 1.3%).

Conclusion IVC filters have an acceptable safety profile in stroke patients. In our cohort, they were effective in preventing life-threatening PE.

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Footnotes

  • Funding JAH is a shareholder in Intratech.

  • Competing interests SPK has conflict of interest with Angiodynamics.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Massachusetts General Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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