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

Author:

Salim Hamza12ORCID,Musmar Basel3ORCID,Adeeb Nimer4,Yedavalli Vivek1,Lakhani Dhairya1ORCID,Grewal Sahibjot Singh5,El Naamani Kareem3,Henninger Nils6,Sundararajan Sri Hari7,Kühn Anna Luisa8,Khalife Jane9,Ghozy Sherief10,Scarcia Luca11ORCID,Tan Benjamin YQ1213,Regenhardt Robert W2ORCID,Heit Jeremy J14,Cancelliere Nicole M5,Bernstock Joshua D15,Rouchaud Aymeric16,Fiehler Jens17ORCID,Sheth Sunil18,Puri Ajit S8,Dyzmann Christian19,Colasurdo Marco20,Barreau Xavier21,Renieri Leonardo22,Filipe João Pedro23,Harker Pablo24,Radu Răzvan Alexandru25ORCID,Abdalkader Mohamad26,Klein Piers26ORCID,Marotta Thomas R5,Spears Julian5,Ota Takahiro27ORCID,Mowla Ashkan28,Jabbour Pascal3ORCID,Biswas Arundhati29,Clarençon Frédéric30,Siegler James E9,Nguyen Thanh N26ORCID,Varela Ricardo31,Baker Amanda32,Essibayi Muhammed Amir32ORCID,Altschul David32,Gonzalez Nestor R33ORCID,Möhlenbruch Markus A34ORCID,Costalat Vincent25,Gory Benjamin3536,Stracke Christian Paul37,Aziz-Sultan Mohammad Ali15,Hecker Constantin38,Shaikh Hamza9,Liebeskind David S39,Pedicelli Alessandro40,Alexandre Andrea M40,Tancredi Illario41,Faizy Tobias D42,Kalsoum Erwah11,Lubicz Boris43,Patel Aman B2,Pereira Vitor Mendes5,Guenego Adrien43,Dmytriw Adam A25,Amllay Abdelaziz3,Vagal Achala44,ter Schiphorst Adrien45,Thomas Ajith J.10,Gopinathan Anil46,Dusart Anne41,Capirossi Carolina22,Mounayer Charbel47,Weyland Charlotte34,Hsieh Cheng-Yang48,Griessenauer Christoph J.38,Stapleton Christopher J.49,Kalsoum Erwah11,Bellante Flavio41,Marnat Gaultier21,Forestier Géraud47,Shaikh Hamza9,Cuellar-Saenz Hugo H.49,Valente Iacopo40,Sibon Igor50,Rabinov James D.49,Berge Jérôme21,Jesser Jessica34,Carlos Martinez-Gutierrez Juan18,Premat Kevin51,Yeo Leonard LL.46,Chervak Lina44,Meyer Lukas17,Elhorany Mahmoud51,Quintero-Consuegra Miguel52

Affiliation:

1. Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA

2. Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

3. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

4. Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA

5. Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada

6. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

7. Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA

8. Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA

9. Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA

10. Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA

11. Department of Neuroradiology, Henri Mondor Hospital, Creteil, France

12. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

13. Division of Neurology, Department of Medicine, National University Hospital, Singapore

14. Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

15. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA

16. Neuroradiology Department, Dupuytren, University Hospital of Limoges, Université de Limoges, Limoges, France

17. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

18. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

19. Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany

20. Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA

21. Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

22. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

23. Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal

24. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA

25. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France

26. Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA

27. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

28. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Suite, Los Angeles, CA, USA

29. Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA

30. Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University. Paris VI, France

31. Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal

32. Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

33. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

34. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

35. Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France

36. INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France

37. Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Germany

38. Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Austria

39. UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA

40. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy

41. Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

42. Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany

43. Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

44. Department of Neurology and Radiology, University of Cincinnati, USA

45. Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center

46. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore

47. University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252

48. Neurology Department, Sin-Lau Hospital, Tainan, Taiwan

49. Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA

50. Neurology Department, Bordeaux University Hospital, Bordeaux, France

51. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; GRC BioFast. Sorbonne University. Paris VI

52. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA

Abstract

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.

Publisher

SAGE Publications

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3