Mechanical Thrombectomy in Patients with Acute Ischemic Stroke on Anticoagulation Therapy

  • David Černík
  • Daniel Šaňák
  • Petra Divišová
  • Martin Köcher
  • Filip Cihlář
  • Jana Zapletalová
  • Tomáš Veverka
  • Andrea Prcúchová
  • Dušan Ospalík
  • Marie Černá
  • Petra Janoušová
  • Michal Král
  • Tomáš Dorňák
  • Vojtěch Prášil
  • David Franc
  • Petr Kaňovský
Clinical Investigation
  • 18 Downloads

Abstract

Introduction/Purpose

Mechanical thrombectomy (MT) for acute ischemic stroke (IS) can be performed also in patients on anticoagulation therapy (AT); however, sufficient and reliable data about safety and efficacy of MT are still missing. Thus, we aimed to compare these parameters between patients treated on AT and without AT.

Materials and Methods

All consecutive IS patients treated with MT using stent retrievers were included in the retrospective analysis. Neurological deficit was scored using National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale with a score 0–2 for good outcome. Recanalization was rated using Thrombolysis in Cerebral Infarction (TICI) scale. Symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS-MOST criteria.

Results

Out of 703 patients treated with MT, 88 (12.5%) patients (46% males, mean age 75.5 ± 11.8 years) were on AT with an admission median NIHSS of 17 points. Recanalization (TICI 2b-3) was achieved in 80% and complete (TICI 3) in 65% of patients on AT and in 80 and 65% of patients without AT (p—1.000). SICH after MT was detected in 9% of AT and 5% of non-AT patients (p—0.136). Good outcome was present in 36% of AT patients (p—0.03). AT patients with poor outcome had more frequently atrial fibrillation (93%, p—0.005), higher admission NIHSS (17, p—0.004) and higher rate of SICH (14.5%, p—0.047).

Conclusion

MT seems to be safe also in patients on AT. Poor outcome may be related to higher admission NIHSS, higher rate of SICH and presence of atrial fibrillation.

Keywords

Ischemic stroke Mechanical thrombectomy Anticoagulation therapy Symptomatic intracerebral hemorrhage Clinical outcome 

Notes

Acknowledgements

The study was supported by the grant of the IGA LF UP_010_2017, IGA-KZ-2016-1-2 and partially by the grant of Ministry of Health Czech Republic, No. 17-30101A.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • David Černík
    • 1
    • 2
  • Daniel Šaňák
    • 1
  • Petra Divišová
    • 1
  • Martin Köcher
    • 3
  • Filip Cihlář
    • 4
  • Jana Zapletalová
    • 5
  • Tomáš Veverka
    • 1
  • Andrea Prcúchová
    • 1
    • 2
  • Dušan Ospalík
    • 2
  • Marie Černá
    • 3
  • Petra Janoušová
    • 2
    • 6
  • Michal Král
    • 1
  • Tomáš Dorňák
    • 1
  • Vojtěch Prášil
    • 3
  • David Franc
    • 1
  • Petr Kaňovský
    • 1
  1. 1.Department of Neurology, Comprehensive Stroke CenterPalacký University Medical School and HospitalOlomoucCzech Republic
  2. 2.Department of Neurology, Comprehensive Stroke CenterMasaryk HospitalÚstí nad LabemCzech Republic
  3. 3.Department of RadiologyPalacký University Medical School and HospitalOlomoucCzech Republic
  4. 4.Department of RadiologyMasaryk HospitalÚstí nad LabemCzech Republic
  5. 5.Department of Medical Biophysics and StatisticsPalacký University Medical SchoolOlomoucCzech Republic
  6. 6.Department of EmergencyMasaryk HospitalÚstí nad LabemCzech Republic

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