Jan C Purrucker1, Marcel Wolf1, Kirsten Haas1, Timolaos Rizos1, Shujah Khan1, Rainer Dziewas1, Christoph Kleinschnitz1, Andreas Binder1, Klaus Gröschel1, Michael G Hennerici1, Kyriakos Lobotesis1, Sven Poli1, Günter Seidel1, Tobias Neumann-Haefelin1, Peter A Ringleb1, Peter U Heuschmann1, Roland Veltkamp2. 1. From the Departments of Neurology (J.C.P., T.R., S.K., P.A.R., R.V.) and Neuroradiology (M.W.), University Hospital Heidelberg, Heidelberg, Germany; Institute of Clinical Epidemiology and Biometry (K.H., P.U.H.), University of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Münster, Münster, Germany (R.D.); Department of Neurology (C.K.), and Comprehensive Heart Failure Center and Clinical Trial Center (P.U.H.), University Hospital Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Kiel, Kiel, Germany (A.B.); Department of Neurology, University Hospital Mainz, Mainz, Germany (K.G.); Department of Neurology, University Hospital Mannheim, Mannheim, Germany (M.G.H.); Departments of Neuroradiology (K.L.) and Stroke Medicine (R.V.), Imperial College London, London, United Kingdom; Department of Neurology, University Hospital Tübingen, Tübingen, Germany (S.P.); Department of Neurology, Asklepios Klinik Nord, Hamburg, Germany (G.S.); and Department of Neurology, Klinikum Fulda, Fulda, Germany (T.N.-H.). 2. From the Departments of Neurology (J.C.P., T.R., S.K., P.A.R., R.V.) and Neuroradiology (M.W.), University Hospital Heidelberg, Heidelberg, Germany; Institute of Clinical Epidemiology and Biometry (K.H., P.U.H.), University of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Münster, Münster, Germany (R.D.); Department of Neurology (C.K.), and Comprehensive Heart Failure Center and Clinical Trial Center (P.U.H.), University Hospital Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Kiel, Kiel, Germany (A.B.); Department of Neurology, University Hospital Mainz, Mainz, Germany (K.G.); Department of Neurology, University Hospital Mannheim, Mannheim, Germany (M.G.H.); Departments of Neuroradiology (K.L.) and Stroke Medicine (R.V.), Imperial College London, London, United Kingdom; Department of Neurology, University Hospital Tübingen, Tübingen, Germany (S.P.); Department of Neurology, Asklepios Klinik Nord, Hamburg, Germany (G.S.); and Department of Neurology, Klinikum Fulda, Fulda, Germany (T.N.-H.). r.veltkamp@imperial.ac.uk.
Abstract
BACKGROUND AND PURPOSE: Prospective data on the safety of endovascular thrombectomy in acute stroke patients on non-vitamin K antagonist oral anticoagulants are lacking. METHODS: Prospective multicenter observational study. Patients with ischemic stroke undergoing thrombectomy with or without preceding thrombolysis were enrolled into the Registry of Acute Ischemic Stroke Under New Oral Anticoagulants. Baseline characteristics and functional outcome at 3 months were assessed. Hemorrhagic transformation and symptomatic intracranial hemorrhage were analyzed. Reperfusion was graded using the modified Thrombolysis in Cerebral Infarction score. RESULTS: Of 28 patients treated with thrombectomy, 5 had received also systemic thrombolysis (18%). Intracranial hemorrhage was observed in 46%, but symptomatic intracranial hemorrhage occurred only in 1 patient. Successful reperfusion (Thrombolysis in Cerebral Infarction score, 2b-3) was achieved in 59%. At 3 months, 19% had a modified Rankin Scale score of 0 to 2, and mortality was 26%. CONCLUSIONS: Thrombectomy in non-vitamin K antagonist oral anticoagulant patients seems safe although a comparatively high rate of asymptomatic hemorrhagic transformation was noted. Confirmation in larger prospective controlled cohorts is necessary. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01850797.
BACKGROUND AND PURPOSE: Prospective data on the safety of endovascular thrombectomy in acute strokepatients on non-vitamin K antagonist oral anticoagulants are lacking. METHODS: Prospective multicenter observational study. Patients with ischemic stroke undergoing thrombectomy with or without preceding thrombolysis were enrolled into the Registry of Acute Ischemic Stroke Under New Oral Anticoagulants. Baseline characteristics and functional outcome at 3 months were assessed. Hemorrhagic transformation and symptomatic intracranial hemorrhage were analyzed. Reperfusion was graded using the modified Thrombolysis in Cerebral Infarction score. RESULTS: Of 28 patients treated with thrombectomy, 5 had received also systemic thrombolysis (18%). Intracranial hemorrhage was observed in 46%, but symptomatic intracranial hemorrhage occurred only in 1 patient. Successful reperfusion (Thrombolysis in Cerebral Infarction score, 2b-3) was achieved in 59%. At 3 months, 19% had a modified Rankin Scale score of 0 to 2, and mortality was 26%. CONCLUSIONS: Thrombectomy in non-vitamin K antagonist oral anticoagulant patients seems safe although a comparatively high rate of asymptomatic hemorrhagic transformation was noted. Confirmation in larger prospective controlled cohorts is necessary. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01850797.
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