Abhi Pandhi1, Georgios Tsivgoulis2, Muhammad F Ishfaq1, Aristeidis Katsanos3, Georgios Magoufis4, Konark Malhotra5, Rashi Krishnan1, Adam Arthur6, Daniel Hoit6, Lucas Elijovich7, Andrei V Alexandrov1, Ahmad Cheema8, Nitin Goyal9. 1. Department of Neurology, University of Tennessee Health Science Center, United States. 2. Department of Neurology, University of Tennessee Health Science Center, United States; Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece. 3. Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece. 4. Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece. 5. Department of Neurology, West Virginia University-Charleston Division, Charleston, WV, United States. 6. Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, United States. 7. Department of Neurology, University of Tennessee Health Science Center, United States; Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, United States. 8. Department of Neurosurgery, University of Oklahoma-Health Sciences Center, Oklahoma City. 9. Department of Neurology, University of Tennessee Health Science Center, United States. Electronic address: ngoyal@uthsc.edu.
Abstract
OBJECTIVE: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute stroke patients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). METHODS: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0-2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. RESULTS: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14-22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12-21)]. Patients with high INR did not differ in terms of sICH (10.0% vs. 6.9%; p = .706), 3-month mortality (20.0% vs. 24.2%; p = .762), SR (88.9% vs. 69.4%; p = .209) and 3-month FI (50% vs. 49.3%; p = .762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95%CI: 0.42-2.07; p = .88), 3-month mortality (OR: 1.07, 95%CI: CI 0.72-1.60; p = .73) and 3-month FI (OR: 0.69, 95%CI: 0.34-1.40; p = .30). CONCLUSIONS: MT can be performed safely and effectively in ELVO patients with high INR.
OBJECTIVE: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute strokepatients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). METHODS: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0-2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. RESULTS: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14-22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12-21)]. Patients with high INR did not differ in terms of sICH (10.0% vs. 6.9%; p = .706), 3-month mortality (20.0% vs. 24.2%; p = .762), SR (88.9% vs. 69.4%; p = .209) and 3-month FI (50% vs. 49.3%; p = .762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95%CI: 0.42-2.07; p = .88), 3-month mortality (OR: 1.07, 95%CI: CI 0.72-1.60; p = .73) and 3-month FI (OR: 0.69, 95%CI: 0.34-1.40; p = .30). CONCLUSIONS: MT can be performed safely and effectively in ELVO patients with high INR.
Authors: D Michalski; C Jungk; T Brenner; M Dietrich; C Nusshag; M A Weigand; C J Reuß; C Beynon; M Bernhard Journal: Anaesthesist Date: 2020-02 Impact factor: 1.041
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: María E Ramos-Araque; Alba Chavarría-Miranda; Beatriz Gómez-Vicente; Elena López-Cancio Martínez; María Castañón Apilánez; Mar Castellanos; María López Fernández; Herbert Tejada Meza; Javier Marta Moreno; Javier Tejada García; Iria Beltrán Rodríguez; Patricia de la Riva; Noemi Díez; Susana Arias Rivas; María Santamaría Cadavid; Yolanda Bravo Anguiano; Mónica Bártulos Iglesias; Enrique Jesús Palacio Portilla; Marian Revilla García; Juan José Timiraos Fernández; Naroa Arenaza Basterrechea; José Luis Maciñeiras Montero; Pablo Vicente Alba; Francisco José Julián Villaverde; Ana Pinedo Brochado; Itxaso Azkune; Freijo M Mar; Alain Luna; Juan F Arenillas Journal: Front Neurol Date: 2020-11-26 Impact factor: 4.003