Mechanical Thrombectomy in Acute Ischemic Stroke-The Role of Interventional Cardiologists: A Prospective Single-Center Study.
JACC Cardiovasc Interv
; 15(5): 550-558, 2022 03 14.
Article
in En
| MEDLINE
| ID: mdl-35151607
ABSTRACT
OBJECTIVES:
The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality.BACKGROUND:
MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy.METHODS:
In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52).RESULTS:
Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar.CONCLUSIONS:
Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure.Key words
Full text:
1
Collection:
01-internacional
Health context:
6_ODS3_enfermedades_notrasmisibles
Database:
MEDLINE
Main subject:
Brain Ischemia
/
Stroke
/
Endovascular Procedures
/
Cardiologists
/
Ischemic Stroke
Type of study:
Observational_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
JACC Cardiovasc Interv
Year:
2022
Document type:
Article