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Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke.
Salim, Hamza; Musmar, Basel; Adeeb, Nimer; Yedavalli, Vivek; Lakhani, Dhairya; Grewal, Sahibjot Singh; El Naamani, Kareem; Henninger, Nils; Sundararajan, Sri Hari; Kühn, Anna Luisa; Khalife, Jane; Ghozy, Sherief; Scarcia, Luca; Tan, Benjamin Yq; Regenhardt, Robert W; Heit, Jeremy J; Cancelliere, Nicole M; Bernstock, Joshua D; Rouchaud, Aymeric; Fiehler, Jens; Sheth, Sunil; Puri, Ajit S; Dyzmann, Christian; Colasurdo, Marco; Barreau, Xavier; Renieri, Leonardo; Filipe, João Pedro; Harker, Pablo; Radu, Razvan Alexandru; Abdalkader, Mohamad; Klein, Piers; Marotta, Thomas R; Spears, Julian; Ota, Takahiro; Mowla, Ashkan; Jabbour, Pascal; Biswas, Arundhati; Clarençon, Frédéric; Siegler, James E; Nguyen, Thanh N; Varela, Ricardo; Baker, Amanda; Essibayi, Muhammed Amir; Altschul, David; Gonzalez, Nestor R; Möhlenbruch, Markus A; Costalat, Vincent; Gory, Benjamin; Stracke, Christian Paul; Aziz-Sultan, Mohammad Ali.
Afiliación
  • Salim H; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • Musmar B; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Adeeb N; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • Yedavalli V; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
  • Lakhani D; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • Grewal SS; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • El Naamani K; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Henninger N; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • Sundararajan SH; Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
  • Kühn AL; Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
  • Khalife J; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
  • Ghozy S; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
  • Scarcia L; Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
  • Tan BY; Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
  • Regenhardt RW; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Heit JJ; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
  • Cancelliere NM; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Bernstock JD; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
  • Rouchaud A; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Fiehler J; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA.
  • Sheth S; Neuroradiology Department, Dupuytren, University Hospital of Limoges, Université de Limoges, Limoges, France.
  • Puri AS; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Dyzmann C; Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
  • Colasurdo M; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
  • Barreau X; Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
  • Renieri L; Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
  • Filipe JP; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
  • Harker P; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
  • Radu RA; Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
  • Abdalkader M; Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Klein P; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
  • Marotta TR; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Spears J; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Ota T; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Mowla A; Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Jabbour P; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
  • Biswas A; Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Suite, Los Angeles, CA, USA.
  • Clarençon F; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • Siegler JE; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
  • Nguyen TN; Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University. Paris VI, France.
  • Varela R; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
  • Baker A; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Essibayi MA; Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
  • Altschul D; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Gonzalez NR; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Möhlenbruch MA; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Costalat V; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
  • Gory B; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • Stracke CP; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
  • Aziz-Sultan MA; Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
Eur Stroke J ; : 23969873241249295, 2024 May 10.
Article en En | MEDLINE | ID: mdl-38726983
ABSTRACT

BACKGROUND:

Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.

METHODS:

This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications.

RESULTS:

Of the patients, 223 (34%) were on anticoagulation therapy. Anticoagulated patients were older (median age 78 vs 74 years; p < 0.001) and had a higher prevalence of atrial fibrillation (77% vs 26%; p < 0.001). Their baseline National Institutes of Health Stroke Scale (NIHSS) scores were also higher (median 12 vs 9; p = 0.002). Before propensity score matching (PSM), anticoagulated patients had similar rates of favorable 90-day outcomes (mRS 0-1 30% vs 37%, p = 0.1; mRS 0-2 47% vs 50%, p = 0.41) but higher mortality (26% vs 17%, p = 0.008). After PSM, there were no significant differences in outcomes between the two groups.

CONCLUSION:

Anticoagulated patients undergoing MT for AIS due to DMVO did not show significant differences in 90-day mRS outcomes, reperfusion, or hemorrhage compared to non-anticoagulated patients after adjustment for covariates.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos