Kévin Premat1, Olivier Clovet1, Giulia Frasca Polara1, Eimad Shotar1, Bruno Bartolini1, Marion Yger1, Federico Di Maria1, Flore Baronnet1, Silvia Pistocchi1, Raphaël Le Bouc1, Christine Pires1, Nader Sourour1, Sonia Alamowitch1, Yves Samson1, Vincent Degos1, Frédéric Clarençon2. 1. From the Department of Interventional Neuroradiology (K.P., E.S., B.B., F.D.M., S.P., N.S., F.C.), Department of Neuro-Intensive Care (O.C., V.D.), and Department of Vascular Neurology (G.F.P., F.B., R.L., C.P., Y.S.), Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, UPMC University Paris-06, France (E.S., F.B., R.L., S.A., V.D., F.C.); and Department of Vascular Neurology, Saint-Antoine Hospital, Paris, France (M.Y., S.A.). 2. From the Department of Interventional Neuroradiology (K.P., E.S., B.B., F.D.M., S.P., N.S., F.C.), Department of Neuro-Intensive Care (O.C., V.D.), and Department of Vascular Neurology (G.F.P., F.B., R.L., C.P., Y.S.), Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, UPMC University Paris-06, France (E.S., F.B., R.L., S.A., V.D., F.C.); and Department of Vascular Neurology, Saint-Antoine Hospital, Paris, France (M.Y., S.A.). fredclare5@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Perioperative strokes (POS) are rare but serious complications for which mechanical thrombectomy could be beneficial. We aimed to compare the technical results and patients outcomes in a population of POS versus non-POS (nPOS) treated by mechanical thrombectomy. METHODS: From 2010 to 2017, 25 patients with POS (ie, acute ischemic stroke occurring during or within 30 days after a procedure) who underwent mechanical thrombectomy (POS group) were enrolled and paired with 50 consecutive patients with nPOS (control group), based on the occlusion's site, National Institute of Health Stroke Scale, and age. RESULTS: Respectively, mean age was 68.3±16.6 versus 67.2±16.6 years (P=0.70), and median National Institute of Health Stroke Scale score at admission was 20 (interquartile range, 15-25) versus 19 (interquartile range, 17-25; P=0.79). Good clinical outcome (modified Rankin Scale score of 0-2 at 3 months) was achieved by 33.3% (POS) versus 56.5% (nPOS) of patients (P=0.055). Successful reperfusion (modified Thrombolysis In Cerebral Infarction score of ≥2b) was obtained in 76% (POS) versus 86% (nPOS) of cases (P=0.22). Mortality at 3 months was 33.3% in the POS group versus 4.2% (nPOS) (P=0.002). The rate of major procedural complications was 4% (POS) versus 6% (nPOS); none were lethal. Average time from symptoms' onset to reperfusion was 4.9 hours (±2.0) in POS versus 5.2 hours (±2.6). CONCLUSIONS: Successful reperfusion seems accessible in POS within a reasonable amount of time and with a good level of safety. However, favorable outcome was achieved with a lower rate than in nPOS, owing to a higher mortality rate.
BACKGROUND AND PURPOSE: Perioperative strokes (POS) are rare but serious complications for which mechanical thrombectomy could be beneficial. We aimed to compare the technical results and patients outcomes in a population of POS versus non-POS (nPOS) treated by mechanical thrombectomy. METHODS: From 2010 to 2017, 25 patients with POS (ie, acute ischemic stroke occurring during or within 30 days after a procedure) who underwent mechanical thrombectomy (POS group) were enrolled and paired with 50 consecutive patients with nPOS (control group), based on the occlusion's site, National Institute of Health Stroke Scale, and age. RESULTS: Respectively, mean age was 68.3±16.6 versus 67.2±16.6 years (P=0.70), and median National Institute of Health Stroke Scale score at admission was 20 (interquartile range, 15-25) versus 19 (interquartile range, 17-25; P=0.79). Good clinical outcome (modified Rankin Scale score of 0-2 at 3 months) was achieved by 33.3% (POS) versus 56.5% (nPOS) of patients (P=0.055). Successful reperfusion (modified Thrombolysis In Cerebral Infarction score of ≥2b) was obtained in 76% (POS) versus 86% (nPOS) of cases (P=0.22). Mortality at 3 months was 33.3% in the POS group versus 4.2% (nPOS) (P=0.002). The rate of major procedural complications was 4% (POS) versus 6% (nPOS); none were lethal. Average time from symptoms' onset to reperfusion was 4.9 hours (±2.0) in POS versus 5.2 hours (±2.6). CONCLUSIONS: Successful reperfusion seems accessible in POS within a reasonable amount of time and with a good level of safety. However, favorable outcome was achieved with a lower rate than in nPOS, owing to a higher mortality rate.
Authors: Sebastian Mönch; Manuel Lehm; Christian Maegerlein; Dennis Hedderich; Maria Berndt; Tobias Boeckh-Behrens; Silke Wunderlich; Kornelia Kreiser; Claus Zimmer; Benjamin Friedrich Journal: J Neurol Date: 2018-08-28 Impact factor: 4.849