RT Journal Article
SR Electronic
T1 Mechanical thrombectomy in ischemic stroke after cardiovascular procedures: a propensity-matched cohort analysis
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP e129
OP e135
DO 10.1136/jnis-2022-019152
VO 15
IS e1
A1 Bay, Benjamin
A1 Gloyer, Nils-Ole
A1 Remmel, Marko
A1 Schell, Maximilian
A1 Zelenak, Kamil
A1 Seiffert, Moritz
A1 Brunner, Fabian J
A1 Clemmensen, Peter
A1 Reichenspurner, Hermann
A1 Blankenberg, Stefan
A1 Thomalla, Goetz
A1 Fiehler, Jens
A1 Conradi, Lenard
A1 Waldeyer, Christoph
A1 Flottmann, Fabian
YR 2023
UL http://jnis.bmj.com/content/15/e1/e129.abstract
AB Background Stroke after a cardiovascular procedure (CVP) is a devastating complication adversely affecting outcome. Mechanical thrombectomy (MT) has not been investigated systematically in this population.Objective To carry out a retrospective study in patients undergoing MT for early stroke after CVP, aiming to further characterize this cohort of patients, and to evaluate the efficacy, safety, procedural characteristics, and outcome of MT.Methods A single-center stroke registry of patients who received MT was analyzed. Baseline and procedural parameters, mortality, functional outcome, recanalization rates, and complications were evaluated. Propensity score matching was carried out, identifying a control cohort with non-periprocedural large vessel occlusion (LVO).Results Overall 913 patients were included (mean age 73.0 (±13.0) years, 52.5% female, median National Institutes of Health Stroke Scale score 15 (10–19)). Eleven patients with a LVO after a recent (<30 days postoperatively) CVP were identified (n=3 transcatheter aortic valve and n=1 surgical aortic valve replacements (SAVR), n=3 coronary bypass grafting (CABG) surgeries, n=2 SAVR+CABG, and n=2 aortic surgeries). After matching, 8 patients in the CVP group were compared with 16 patients in the matched cohort. Comparable rates of reperfusion were achieved. Time from symptom onset to groin puncture (171.5 min (136.3, 178.3) vs 284.0 min (215.0, 490.5); p=0.039), as well as recanalization (195.0 min (146.0, 201.0) vs 419.0 min (274.0, 613.0); p=0.028) was faster in the CVP group. However, this was not reflected by an improved outcome (modified Rankin Scale score after 90 days: 5.5 (3.3, 6.0) vs 5.0 (4.0, 6.0), mortality after 90 days 50.0% vs 37.5%). Complications did not differ between the groups.Conclusions Use of MT for LVO stroke in patients after a recent CVP is a safe and efficient treatment in comparison with patients with a non-periprocedural LVO undergoing MT.Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.