ACUTE ISCHEMIC STROKE MECHANICAL THROMBECTOMY BY INTERVENTIONAL CARDIOLOGISTS: 2-YEAR SINGLE-CENTRE EXPERIENCE

Research output

Abstract

BACKGROUND Acute occlusions of intracranial and extracranial vessels remain an important cause of acute ischemic stroke especially in patients with atrial fibrillation and without proper anticoagulation. Because of the invalidating consequences of acute ischemic stroke caused by large-vessel occlusion, combined reperfusion strategy and endovascular management should be utilized as a first step in patient’s therapy, especially after the 5 groundbreaking randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT and SWIFT PRIME). After 2 years of acute ischemic stroke treatment program onset in our hospital, we intended to answer the question if it is feasible to achieve similar results in an emergency cardiologic center. OBJECTIVE To analyze the data from our prospective observational registry and compared it with the major stroke trials METHODS We analyzed the data from our prospective observational registry and compared it with the major trials. RESULTS We studied 79 patients, with a mean age of 71,2 years and 51,8% men. The population was comparable in the majority of selection criteria and baseline characteristics. The rate of previous intravenous thrombolysis (25 patients, 31,6%) was significantly lower in our registry than in 5 major trials. Modified Rankin Scale less than 3 at 90 days was achieved in less than two-thirds of the patients (45 patients, 56,9%), lower than in the referred trials. We followed rapid self-made hospital protocol of fast recanalization, using computed tomography angiography, computed tomography perfusion and direct catheterization laboratory activation by the neurologist on-duty. We achieved a successful recanalization rate of 77,2% (61 patient), 5% (4 patients) symptomatic intracranial hemorrhage and 8,8% mortality (7 patients) in the <75 years-old group. CONCLUSION Mechanical thrombectomy performed by the experienced interventional cardiologists trained in acute ischemic stroke treatment seems to be a safe and effective treatment option in a "real-world" scenario, with results slightly lower to those of the randomized controlled trials. We believe that our results were biased by significantly lower utilization of intravenous thrombolysis, which will be addressed in our future work.
Original languageEnglish
Publication statusPublished - 12 Mar 2019
EventICCA Stroke 2019 - All India Institute of Medical Sciences, New Delhi
Duration: 11 Mar 201912 Mar 2019
https://www.iccaonline.org

Conference

ConferenceICCA Stroke 2019
CountryIndia
CityNew Delhi
Period11/03/1912/03/19
Internet address

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Thrombectomy
Stroke
Registries
Cardiologists
Intracranial Hemorrhages
Therapeutics
Catheterization
Atrial Fibrillation
Patient Selection
Reperfusion
Emergencies
Randomized Controlled Trials
Perfusion
Tomography
Mortality

Cite this

@conference{360129c9ec7a4a89bf414c39ae84ad5a,
title = "ACUTE ISCHEMIC STROKE MECHANICAL THROMBECTOMY BY INTERVENTIONAL CARDIOLOGISTS: 2-YEAR SINGLE-CENTRE EXPERIENCE",
abstract = "BACKGROUND Acute occlusions of intracranial and extracranial vessels remain an important cause of acute ischemic stroke especially in patients with atrial fibrillation and without proper anticoagulation. Because of the invalidating consequences of acute ischemic stroke caused by large-vessel occlusion, combined reperfusion strategy and endovascular management should be utilized as a first step in patient’s therapy, especially after the 5 groundbreaking randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT and SWIFT PRIME). After 2 years of acute ischemic stroke treatment program onset in our hospital, we intended to answer the question if it is feasible to achieve similar results in an emergency cardiologic center. OBJECTIVE To analyze the data from our prospective observational registry and compared it with the major stroke trials METHODS We analyzed the data from our prospective observational registry and compared it with the major trials. RESULTS We studied 79 patients, with a mean age of 71,2 years and 51,8{\%} men. The population was comparable in the majority of selection criteria and baseline characteristics. The rate of previous intravenous thrombolysis (25 patients, 31,6{\%}) was significantly lower in our registry than in 5 major trials. Modified Rankin Scale less than 3 at 90 days was achieved in less than two-thirds of the patients (45 patients, 56,9{\%}), lower than in the referred trials. We followed rapid self-made hospital protocol of fast recanalization, using computed tomography angiography, computed tomography perfusion and direct catheterization laboratory activation by the neurologist on-duty. We achieved a successful recanalization rate of 77,2{\%} (61 patient), 5{\%} (4 patients) symptomatic intracranial hemorrhage and 8,8{\%} mortality (7 patients) in the <75 years-old group. CONCLUSION Mechanical thrombectomy performed by the experienced interventional cardiologists trained in acute ischemic stroke treatment seems to be a safe and effective treatment option in a {"}real-world{"} scenario, with results slightly lower to those of the randomized controlled trials. We believe that our results were biased by significantly lower utilization of intravenous thrombolysis, which will be addressed in our future work.",
author = "Хильчук, {Антон Андреевич} and Щербак, {Сергей Григорьевич} and Сарана, {Андрей Михайлович} and Власенко, {Сергей Васильевич} and М.В. Агарков",
year = "2019",
month = "3",
day = "12",
language = "English",
note = "ICCA Stroke 2019 ; Conference date: 11-03-2019 Through 12-03-2019",
url = "https://www.iccaonline.org",

}

TY - CONF

T1 - ACUTE ISCHEMIC STROKE MECHANICAL THROMBECTOMY BY INTERVENTIONAL CARDIOLOGISTS: 2-YEAR SINGLE-CENTRE EXPERIENCE

AU - Хильчук, Антон Андреевич

AU - Щербак, Сергей Григорьевич

AU - Сарана, Андрей Михайлович

AU - Власенко, Сергей Васильевич

AU - Агарков, М.В.

PY - 2019/3/12

Y1 - 2019/3/12

N2 - BACKGROUND Acute occlusions of intracranial and extracranial vessels remain an important cause of acute ischemic stroke especially in patients with atrial fibrillation and without proper anticoagulation. Because of the invalidating consequences of acute ischemic stroke caused by large-vessel occlusion, combined reperfusion strategy and endovascular management should be utilized as a first step in patient’s therapy, especially after the 5 groundbreaking randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT and SWIFT PRIME). After 2 years of acute ischemic stroke treatment program onset in our hospital, we intended to answer the question if it is feasible to achieve similar results in an emergency cardiologic center. OBJECTIVE To analyze the data from our prospective observational registry and compared it with the major stroke trials METHODS We analyzed the data from our prospective observational registry and compared it with the major trials. RESULTS We studied 79 patients, with a mean age of 71,2 years and 51,8% men. The population was comparable in the majority of selection criteria and baseline characteristics. The rate of previous intravenous thrombolysis (25 patients, 31,6%) was significantly lower in our registry than in 5 major trials. Modified Rankin Scale less than 3 at 90 days was achieved in less than two-thirds of the patients (45 patients, 56,9%), lower than in the referred trials. We followed rapid self-made hospital protocol of fast recanalization, using computed tomography angiography, computed tomography perfusion and direct catheterization laboratory activation by the neurologist on-duty. We achieved a successful recanalization rate of 77,2% (61 patient), 5% (4 patients) symptomatic intracranial hemorrhage and 8,8% mortality (7 patients) in the <75 years-old group. CONCLUSION Mechanical thrombectomy performed by the experienced interventional cardiologists trained in acute ischemic stroke treatment seems to be a safe and effective treatment option in a "real-world" scenario, with results slightly lower to those of the randomized controlled trials. We believe that our results were biased by significantly lower utilization of intravenous thrombolysis, which will be addressed in our future work.

AB - BACKGROUND Acute occlusions of intracranial and extracranial vessels remain an important cause of acute ischemic stroke especially in patients with atrial fibrillation and without proper anticoagulation. Because of the invalidating consequences of acute ischemic stroke caused by large-vessel occlusion, combined reperfusion strategy and endovascular management should be utilized as a first step in patient’s therapy, especially after the 5 groundbreaking randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT and SWIFT PRIME). After 2 years of acute ischemic stroke treatment program onset in our hospital, we intended to answer the question if it is feasible to achieve similar results in an emergency cardiologic center. OBJECTIVE To analyze the data from our prospective observational registry and compared it with the major stroke trials METHODS We analyzed the data from our prospective observational registry and compared it with the major trials. RESULTS We studied 79 patients, with a mean age of 71,2 years and 51,8% men. The population was comparable in the majority of selection criteria and baseline characteristics. The rate of previous intravenous thrombolysis (25 patients, 31,6%) was significantly lower in our registry than in 5 major trials. Modified Rankin Scale less than 3 at 90 days was achieved in less than two-thirds of the patients (45 patients, 56,9%), lower than in the referred trials. We followed rapid self-made hospital protocol of fast recanalization, using computed tomography angiography, computed tomography perfusion and direct catheterization laboratory activation by the neurologist on-duty. We achieved a successful recanalization rate of 77,2% (61 patient), 5% (4 patients) symptomatic intracranial hemorrhage and 8,8% mortality (7 patients) in the <75 years-old group. CONCLUSION Mechanical thrombectomy performed by the experienced interventional cardiologists trained in acute ischemic stroke treatment seems to be a safe and effective treatment option in a "real-world" scenario, with results slightly lower to those of the randomized controlled trials. We believe that our results were biased by significantly lower utilization of intravenous thrombolysis, which will be addressed in our future work.

M3 - Poster

ER -