Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients. (30th March 2018)

• Record Type: Journal Article
• Authors: L'Allinec, Vincent; Ernst, Marielle; Sevin-Allouet, Mathieu; Testard, Nathalie; Delasalle-Guyomarch, Béatrice; Guillon, Benoit; Mazighi, Mikael; Desal, Hubert; Bourcier, Romain
• Other Names: author non-byline.; M Roy author non-byline.; A Gaultier author non-byline.; B Daumas-Duport author non-byline.; O Catar author non-byline.; A Lecluse author non-byline.; S Godard author non-byline.; M Guillaume author non-byline.; A Pasco author non-byline.; I Lemoine author non-byline.; S Ledure author non-byline.; F Rouanet author non-byline.; I Sibon author non-byline.; X Barreau author non-byline.; J Berge author non-byline.; P Menegon author non-byline.; V Dousset author non-byline.; B Lamande author non-byline.; A Ferrier author non-byline.; B Jean author non-byline.; E Chabert author non-byline.; J Gabrillarges author non-byline.; N Behechti author non-byline.; A Kazemi author non-byline.; F Ricolfi author non-byline.; M Proust author non-byline.; F Tahon author non-byline.; A Vasdev author non-byline.; F Boustia author non-byline.; E Kalsoum author non-byline.; P Aguettaz author non-byline.; X Leclerc author non-byline.; S Saleme author non-byline.; C Mounayer author non-byline.; S Saleme author non-byline.; G Gautier author non-byline.; H Brunel author non-byline.; R Tonnelet author non-byline.; R Anxionnat author non-byline.; S Bracard author non-byline.; M Moynier author non-byline.; C Riquelme author non-byline.; P Machi author non-byline.; C Arquizan author non-byline.; V Costalat author non-byline.; A Bonafe author non-byline.; G Arnoult author non-byline.; L Pierot author non-byline.; F Kestens author non-byline.; T Ronziere author non-byline.; JY Gauvrit author non-byline.; AC Januel author non-byline.; F Bonneville author non-byline.; C Cognard author non-byline.; C Papagiannaki author non-byline.; R Bibi author non-byline.; D Herbreteau author non-byline.; O Naggara author non-byline.; F Puccinelli author non-byline.; B Lapergue author non-byline.; O Coskun author non-byline.; P Guedin author non-byline.; G Rodesch author non-byline.; H Hosseini author non-byline.; T Tuilier author non-byline.; S Gallas author non-byline.; A Gaston author non-byline.; H Redjem author non-byline.; AS Pellen author non-byline.; M Abricard author non-byline.; R Blanc author non-byline.; M Piotin author non-byline.; B Gory author non-byline.; R Riva author non-byline.; F Di Maria author non-byline.; N Sourour author non-byline.; F Clarencon author non-byline.; L Blanchard author non-byline.; S Velasco author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 10:Number 12(2018)
• Page Start: e29
• Page End: e29
• Publication Date: 2018-03-30
• Subjects: stroke -- mechanical thrombectomy -- anticoagulant -- safety; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2017-013714
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Anticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs. Methods: We analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups. Results: 333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups. Conclusions: With regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group.