María Alonso de Leciñana1,2, Patricia Martínez-Sánchez1, Andrés García-Pastor3, Michal M Kawiorski2, Patricia Calleja4, Borja E Sanz-Cuesta1, Fernando Díaz-Otero3, Remedios Frutos5, Fernando Sierra-Hidalgo6,7, Gerardo Ruiz-Ares1, Eduardo Fandiño8, Exuperio Díez-Tejedor1, Antonio Gil-Nuñez3, Blanca Fuentes1. 1. Department of Neurology, Stroke Centre, La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain. 2. Department of Neurology, Stroke Centre, University Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain. 3. Department of Neurology, Stroke Centre, University Hospital Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain. 4. Department of Neurology, Stroke Centre, University Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain. 5. Department of Neuroradiology, Stroke Centre, La Paz University Hospital, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain. 6. Department of Neuroradiology, Infanta Leonor University Hospital, Universidad Rey Juan Carlos, Madrid, Spain. 7. Department of Neuroradiology, Stroke Center, University Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain. 8. Department of Neuroradiology, Stroke Centre, University Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain.
Abstract
BACKGROUND AND PURPOSE: The present study was conducted with the objective of evaluating the safety of primary mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke and comorbidities that preclude treatment with IV thrombolysis (IVT), compared with patients who received standard IVT treatment followed by MT. Secondary objectives were to analyse the recanalization rate and outcomes. METHODS: A prospective observational multicenter study (FUN-TPA) that recruited patients treated within 4.5 hours of symptom onset was performed. Treatments were IVT followed by MT if occlusion persisted, or primary MT when IVT was contraindicated. Outcome measures were procedural complications, symptomatic intracranial hemorrhage (SICH), recanalization rate, National Institutes of Health Stroke Scale (NIHSS) score at 7 days, modified Rankin Scale (mRS) score and mortality at 90 days. RESULTS: Of 131 patients, 21 (16%) had medical contraindications for IVT and were treated primarily with MT whereas 110 (84%) underwent IVT, followed by MT in 53 cases (40%). The recanalization rate and procedural complications were similar in the two groups. There were no SICHs after primary MT vs 3 (6%) after IVT+MT. Nine patients (43%) in the primary MT group achieved independence (mRS 0-2) compared with 36 (68%) in the IVT+MT group (p=0.046). Mortality rates in the two groups were 14% (n=3) vs 4% (n=2) (p=0.13). Adjusted ORs for independence in patients receiving standard IVT+MT vs MT in patients with medical contraindications for IVT were 2.8 (95% CI 0.99 to 7.98) and 0.24 (95% CI 0.04 to 1.52) for mortality. CONCLUSIONS: MT is safe in patients with potential comorbidity-derived risks that preclude IVT. MT should be offered, aiming for prompt recanalization, to patients with LVO stroke unsuitable for IVT. TRIAL REGISTRATION NUMBER: NCT02164357; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND AND PURPOSE: The present study was conducted with the objective of evaluating the safety of primary mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke and comorbidities that preclude treatment with IV thrombolysis (IVT), compared with patients who received standard IVT treatment followed by MT. Secondary objectives were to analyse the recanalization rate and outcomes. METHODS: A prospective observational multicenter study (FUN-TPA) that recruited patients treated within 4.5 hours of symptom onset was performed. Treatments were IVT followed by MT if occlusion persisted, or primary MT when IVT was contraindicated. Outcome measures were procedural complications, symptomatic intracranial hemorrhage (SICH), recanalization rate, National Institutes of Health Stroke Scale (NIHSS) score at 7 days, modified Rankin Scale (mRS) score and mortality at 90 days. RESULTS: Of 131 patients, 21 (16%) had medical contraindications for IVT and were treated primarily with MT whereas 110 (84%) underwent IVT, followed by MT in 53 cases (40%). The recanalization rate and procedural complications were similar in the two groups. There were no SICHs after primary MT vs 3 (6%) after IVT+MT. Nine patients (43%) in the primary MT group achieved independence (mRS 0-2) compared with 36 (68%) in the IVT+MT group (p=0.046). Mortality rates in the two groups were 14% (n=3) vs 4% (n=2) (p=0.13). Adjusted ORs for independence in patients receiving standard IVT+MT vs MT in patients with medical contraindications for IVT were 2.8 (95% CI 0.99 to 7.98) and 0.24 (95% CI 0.04 to 1.52) for mortality. CONCLUSIONS: MT is safe in patients with potential comorbidity-derived risks that preclude IVT. MT should be offered, aiming for prompt recanalization, to patients with LVO stroke unsuitable for IVT. TRIAL REGISTRATION NUMBER: NCT02164357; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Tasneem F Hasan; Nathaniel Todnem; Neethu Gopal; David A Miller; Sukhwinder S Sandhu; Josephine F Huang; Rabih G Tawk Journal: Curr Cardiol Rep Date: 2019-08-30 Impact factor: 2.931
Authors: Vicky Chalos; Natalie E LeCouffe; Maarten Uyttenboogaart; Hester F Lingsma; Maxim J H L Mulder; Esmee Venema; Kilian M Treurniet; Omid Eshghi; H Bart van der Worp; Aad van der Lugt; Yvo B W E M Roos; Charles B L M Majoie; Diederik W J Dippel; Bob Roozenbeek; Jonathan M Coutinho Journal: J Am Heart Assoc Date: 2019-05-29 Impact factor: 5.501