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Case series
Endovascular management of acute large vessel occlusion stroke in pregnancy is safe and feasible
  1. Kaustubh Limaye1,2,
  2. Ann Van de Walle Jones3,
  3. Amir Shaban3,
  4. Shashvat Desai4,
  5. Sami Al Kasab5,
  6. Eyad Almallouhi5,
  7. Christine A Holmstedt5,
  8. Santiago Ortega-Gutierrez2,
  9. Diogo C Haussen6,
  10. Raul Nogueira6,
  11. Francisco Mont’Alverne7,
  12. Carlos Ragiotto8,
  13. Leticia C Rebello9,10,
  14. Tudor G Jovin11,
  15. David Hasan12,
  16. Ashutosh Jadhav4
  1. 1 Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Division of Neurointerventional Surgery-Interventional Neuroradiology, University of Iowa, Iowa City, Iowa, USA
  3. 3 Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  4. 4 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5 Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  6. 6 Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Marcus Stroke and Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA
  7. 7 Neurology, Hospital General de Fortaleza, Fortaleza, Brazil
  8. 8 Neurology, Hospitas das Clinicas Samuel Libania, Pouso Alegre, Brazil
  9. 9 Neurology, Emory University School of Medicine/Marcus Stroke and Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA
  10. 10 Neurology, Hospital Brasilia, Brasilia, Brazil
  11. 11 Neurology, Cooper University Hospital, Camden, New Jersey, USA
  12. 12 Neurological Surgery, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Ashutosh Jadhav, Neurology, University of Pittsburgh, Pittsburgh, PA 15218, USA; jadhavap{at}upmc.edu

Abstract

Introduction Stroke is a leading cause of adult death and disability. Although acute ischemic stroke (AIS) in pregnancy is rare, it has devastating consequences on the life of the mother and fetus. Pregnancy was an exclusion criterion in endovascular thrombectomy (EVT) trials and so there are no evidence-based treatment recommendations in this subgroup. The objective of this study was to evaluate the safety and feasibility of mechanical thrombectomy in large vessel occlusion (LVO) stroke in pregnancy.

Methods Patients with AIS due to LVO treated with EVT during pregnancy between 2000 and 2019 were identified at seven tertiary care centers. After IRB approval, retrospective analysis of prospectively maintained stroke/endovascular databases was performed.

Results A total of seven subjects were identified. The average age was 33.2 years (range 25–38 years) and the average initial National Institutes of Health Stroke Scale (NIHSS) score at presentation was 15 (range 9–28). Three patients received IV tissue plasminogen activator. Techniques of EVT included stent retriever thrombectomy, stent retriever-assisted continuous aspiration, direct contact aspiration, and multimodal techniques including a rescue balloon mounted coronary stent placement. While one patient was noted to have petechial hemorrhage, no individuals developed parenchymal hematoma. Mean discharge NIHSS score was 1.7 (range 0–5).

Conclusion EVT is a safe and effective treatment for acute stroke secondary to LVO in this series of pregnant patients. While EVT for acute stroke is standard of care in select patient populations, our study suggests that treatment should be considered in the gravid population.

  • stroke
  • thrombectomy
  • brain
  • thrombolysis
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Footnotes

  • Twitter @kaustubhslimaye

  • Contributors All authors were involved in all of the following: (1) conception and design, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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