Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

被引：21

作者：

Salim, Hamza ^{[1
,2
,3
]}

Musmar, Basel ^{[4
]}

Adeeb, Nimer ^{[5
]}

Yedavalli, Vivek ^{[1
]}

Lakhani, Dhairya ^{[1
]}

Grewal, Sahibjot Singh ^{[6
]}

El Naamani, Kareem ^{[4
]}

Henninger, Nils ^{[7
]}

Sundararajan, Sri Hari ^{[8
]}

Kuehn, Anna Luisa ^{[9
]}

Khalife, Jane ^{[10
]}

Ghozy, Sherief ^{[11
,12
]}

Scarcia, Luca ^{[13
]}

Tan, Benjamin Y. Q. ^{[14
,15
]}

Regenhardt, Robert W. ^{[2
,3
]}

Heit, Jeremy J. ^{[16
]}

Cancelliere, Nicole M. ^{[6
]}

Bernstock, Joshua D. ^{[17
]}

Rouchaud, Aymeric ^{[18
]}

Fiehler, Jens ^{[19
]}

Sheth, Sunil ^{[20
]}

Puri, Ajit S. ^{[9
]}

Dyzmann, Christian ^{[21
]}

Colasurdo, Marco ^{[22
]}

Barreau, Xavier ^{[23
]}

Renieri, Leonardo ^{[24
]}

Filipe, Joo Pedro ^{[25
]}

Harker, Pablo ^{[26
]}

Radu, Razvan Alexandru ^{[27
]}

Abdalkader, Mohamad ^{[28
,29
]}

Klein, Piers ^{[28
,29
]}

Marotta, Thomas R. ^{[6
]}

Spears, Julian ^{[6
]}

Ota, Takahiro ^{[30
]}

Mowla, Ashkan ^{[31
]}

Jabbour, Pascal ^{[4
]}

Biswas, Arundhati ^{[32
]}

Clarencon, Frederic ^{[33
]}

Siegler, James E. ^{[10
]}

Nguyen, Thanh N. ^{[28
,29
]}

Varela, Ricardo ^{[34
]}

Baker, Amanda ^{[35
,36
]}

Essibayi, Muhammed Amir ^{[35
,36
]}

Altschul, David ^{[35
,36
]}

Gonzalez, Nestor R. ^{[37
]}

Moehlenbruch, Markus A. ^{[38
]}

Costalat, Vincent ^{[27
]}

Gory, Benjamin ^{[39
,40
]}

Stracke, Christian Paul ^{[41
]}

Aziz-Sultan, Mohammad Ali ^{[17
]}

机构：

[1] Johns Hopkins Med Ctr, Div Neuroradiol, Dept Radiol, Baltimore, MD USA

[2] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA USA

[4] Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA

[5] Louisiana State Univ, Dept Neurosurg & Intervent Neuroradiol, Baton Rouge, LA USA

[6] Univ Toronto, St Michael Hosp, Div Therapeut Neuroradiol & Neurosurg, Neurovasc Ctr, Toronto, ON, Canada

[7] Univ Massachusetts Chan Med Sch, Dept Neurol, Worcester, MA USA

[8] NJMS, Dept Endovasc Neurosurg & Neuroradiol, Newark, NJ USA

[9] Univ Massachusetts Med Ctr, Div Neurointervent Radiol, Dept Radiol, Worcester, MA USA

[10] Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA

[11] Mayo Clin, Dept Neurol Surg, Rochester, MN USA

[12] Mayo Clin, Dept Radiol, Rochester, MN USA

[13] Henri Mondor Hosp, Dept Neuroradiol, Creteil, France

[14] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore

[15] Natl Univ Singapore Hosp, Dept Med, Div Neurol, Singapore, Singapore

[16] Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA

[17] Harvard Med Sch, Brigham & Womens Hosp, Dept Neurosurg, Boston, MA USA

[18] Univ Limoges, Univ Hosp Limoges, Dept Neuroradiol, Dupuytren, Limoges, France

[19] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[20] UTHealth McGovern Med Sch, Dept Neurol, Houston, TX USA

[21] Lubeck GmbH, Sana Klin, Dept Neuroradiol, Lubeck, Germany

[22] Oregon Hlth & Sci Univ, Dept Intervent Radiol, Portland, OR USA

[23] Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France

[24] Osped Careggi Firenze, Interventist Neurovascol, Florence, Italy

[25] Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal

[26] Univ Cincinnati Med Ctr, Dept Neurol, Cincinnati, OH USA

[27] Montpellier Univ Med Ctr, Gui de Chauliac Hosp, Dept Neuroradiol, Montpellier, France

[28] Boston Med Ctr, Dept Radiol, Boston, MA USA

[29] Boston Med Ctr, Dept Neurol, Boston, MA USA

[30] Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan

[31] Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovasc Neurosurg, Los Angeles, CA USA

[32] New York Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[33] Sorbonne Univ Paris VI, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France

[34] Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal

[35] Albert Einstein Coll Med, Dept Neurol Surg, Montefiore Med Ctr, Bronx, NY USA

[36] Albert Einstein Coll Med, Montefiore Einstein Cerebrovasc, Montefiore Med Ctr, Bronx, NY USA

[37] Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA

[38] Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany

[39] Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France

[40] Univ Lorraine, INSERM 1254, IADI, Vandoeuvre Les Nancy, France

[41] Univ Med Ctr Munster, Intervent Neuroradiol Sect, Dept Radiol, Munster, Germany

[42] Paracelsus Med Univ Salzburg, Christian Doppler Clin, Dept Neurol, Salzburg, Austria

[43] Paracelsus Med Univ Salzburg, Christian Doppler Clin, Dept Neurosurg, Salzburg, Austria

[44] UCLA, UCLA Stroke Ctr, Los Angeles, CA USA

[45] UCLA, Dept Neurol Dept, Los Angeles, CA USA

[46] Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy

[47] Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium

[48] Univ Med Ctr Munster, Neuroendovasc Program, Dept Radiol, Munster, Germany

[49] Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium

来源：

EUROPEAN STROKE JOURNAL | 2024年 / 9卷 / 04期

基金：

美国国家卫生研究院;

关键词：

Stroke; thrombectomy; anticoagulation; ACUTE ISCHEMIC-STROKE; ENDOVASCULAR TREATMENT; ORAL ANTICOAGULANTS; ATRIAL-FIBRILLATION; SAFETY; EFFICACY; THERAPY;

D O I：

10.1177/23969873241249295

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood. Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications. Results: Of the patients, 223 (34%) were on anticoagulation therapy. Anticoagulated patients were older (median age 78 vs 74years; p<0.001) and had a higher prevalence of atrial fibrillation (77% vs 26%; p<0.001). Their baseline National Institutes of Health Stroke Scale (NIHSS) scores were also higher (median 12 vs 9; p=0.002). Before propensity score matching (PSM), anticoagulated patients had similar rates of favorable 90-day outcomes (mRS 0-1: 30% vs 37%, p=0.1; mRS 0-2: 47% vs 50%, p=0.41) but higher mortality (26% vs 17%, p=0.008). After PSM, there were no significant differences in outcomes between the two groups. Conclusion: Anticoagulated patients undergoing MT for AIS due to DMVO did not show significant differences in 90-day mRS outcomes, reperfusion, or hemorrhage compared to non-anticoagulated patients after adjustment for covariates.

引用

页码：896 / 906

页数：11

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