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

被引：14

作者：

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

Musmar, Basel ^{[4
]}

Adeeb, Nimer ^{[5
]}

Yedavalli, Vivek ^{[1
]}

Lakhani, Dhairya ^{[1
]}

Grewal, Sahibjot Singh ^{[6
,7
]}

El Naamani, Kareem ^{[4
]}

Henninger, Nils ^{[8
]}

Sundararajan, Sri Hari ^{[9
]}

Kuhn, Anna Luisa ^{[10
]}

Khalife, Jane ^{[11
]}

Ghozy, Sherief ^{[12
,13
]}

Scarcia, Luca ^{[14
]}

Tan, Benjamin Y. Q. ^{[15
,16
]}

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

Heit, Jeremy J. ^{[17
]}

Cancelliere, Nicole M. ^{[6
,7
]}

Bernstock, Joshua D. ^{[18
]}

Rouchaud, Aymeric ^{[19
]}

Fiehler, Jens ^{[20
]}

Sheth, Sunil ^{[21
]}

Puri, Ajit S. ^{[10
]}

Dyzmann, Christian ^{[22
]}

Colasurdo, Marco ^{[23
]}

Barreau, Xavier ^{[24
]}

Renieri, Leonardo ^{[25
]}

Filipe, Joao Pedro ^{[26
]}

Harker, Pablo ^{[27
]}

Radu, Razvan Alexandru ^{[28
]}

Abdalkader, Mohamad ^{[29
,30
]}

Klein, Piers ^{[29
,30
]}

Marotta, Thomas R. ^{[6
,7
]}

Spears, Julian ^{[6
,7
]}

Ota, Takahiro ^{[31
]}

Mowla, Ashkan ^{[32
]}

Jabbour, Pascal ^{[4
]}

Biswas, Arundhati ^{[33
]}

Clarencon, Frederic ^{[34
]}

Siegler, James E. ^{[11
]}

Nguyen, Thanh N. ^{[29
,30
]}

Varela, Ricardo ^{[35
]}

Baker, Amanda ^{[36
,37
]}

Essibayi, Muhammed Amir ^{[36
,37
]}

Altschul, David ^{[36
,37
]}

Gonzalez, Nestor R. ^{[38
]}

Moehlenbruch, Markus A. ^{[39
]}

Costalat, Vincent ^{[28
]}

Gory, Benjamin ^{[40
,41
]}

Stracke, Christian Paul ^{[42
]}

Aziz-Sultan, Mohammad Ali ^{[18
]}

机构：

[1] Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, 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, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada

[7] Univ Toronto, St Michael Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada

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

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

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

[11] Rowan Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA

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

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

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

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

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

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

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

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

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

[21] UTHlth, McGovern Med Sch, Dept Neurol, Houston, TX USA

[22] Sana Kliniken Lubeck GmbH, Neuroradiol Dept, Lubeck, Germany

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

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

[25] Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy

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

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

[28] Montpellier Univ, Gui De Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France

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

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

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

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

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

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

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

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

[37] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Cerebrovasc Res Lab, Bronx, NY USA

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

[39] Univ Klinikum Heidelberg, Sekt Vaskulare & Interventionelle Neuroradiol, Heidelberg, Germany

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

[41] Univ Lorraine, INSERM U1254, IADI, Vandoeuvre Les Nancy, France

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

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

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

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

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

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

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

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

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

来源：

EUROPEAN STROKE JOURNAL | 2024年

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; GUIDELINES; MANAGEMENT; THERAPY; UPDATE;

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 90 days 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 74 years; 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

页数：11

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