BACKGROUND: Thrombectomy is an effective treatment for acute ischaemic stroke (AIS). AIMS: The aim of this study was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath lab. METHODS: This was a single-centre, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin Scale (mRS) after three months. RESULTS: Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 patients (13%) had proximal internal carotid artery (ICA) occlusion, 27 patients (13%) had tandem (ICA+MCA) occlusion, 39 patients (18%) had terminal ICA (T-type) occlusion, and 26 patients (12%) had vertebrobasilar (VB) stroke. Favourable clinical outcome (mRS ≤2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but in only 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalisation success (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions. CONCLUSIONS: Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes. Visual summary. Endovascular intervention of isolated MCA or ICA occlusions provides greatest clinical benefit, while interventions in posterior circulation have lower chance for clinical success.

Department of Cardiology 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Zobrazit více v PubMed

World Health Organization (WHO). The Global Burden of Disease: 2015 Update. Geneva, Switzerland: WHO; 2015.

Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JN, Bull LM, Welch SJ, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z Oxford Vascular Study. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet. 2005;366:1773–83. PubMed

O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, Decarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST. Vascular cognitive impairment. Lancet Neurol. 2003;2:89–98. doi: 10.1016/S1474-4422(03)00305-3. PubMed DOI

Mozzafarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics – 2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38–360. PubMed

Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10:1002–14. doi: 10.1016/S1474-4422(11)70229-0. PubMed DOI

Peisker T, Koznar B, Stetkarova I, Widimský P. Acute stroke therapy: A review. Trends Cardiovasc Med. 2017;27:59–66. doi: 10.1016/j.tcm.2016.06.009. PubMed DOI

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46–110. PubMed

Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, Schellinger PD, Toni D, de Vries J, White P, Fiehler J. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11:535–8. doi: 10.1136/neurintsurg-2018-014568. PubMed DOI

Training Guidelines for Endovascular Ischemic Stroke Intervention: An International multi-society consensus document. J Neurointerv Surg. 2016;8:989–91. doi: 10.1136/neurintsurg-2016-012316. PubMed DOI PMC

Widimský P, Asil T, Abelson M, Koznar B, Tasal A, Roos J, Vasko P, Peisker T, Deniz C, Vavrova J, Yamac HA, Stetkarova I, Bacaksiz A, Ay NK, Tuzgen S, Maly M, Goktekin O. Direct Catheter-Based Thrombectomy for Acute Ischemic Stroke: Outcomes of Consecutive Patients Treated in Interventional Cardiology Centers in Close Cooperation With Neurologists. J Am Coll Cardiol. 2015;66:487–8. doi: 10.1016/j.jacc.2015.04.076. PubMed DOI

Lakomkin N, Dhamoon M, Carroll K, Singh IP, Tuhrim S, Lee J, Fifi JT, Mocco J. Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature. J Neurointerv Surg. 2019;11:241–5. doi: 10.1136/neurintsurg-2018-014239. PubMed DOI

Widimský P, Koznar B, Peisker T, Vasko P, Rohac F, Vavrova J, Kroupa J, Stetkarova I. Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischemic stroke. Cooperation among cardiologists, neurologists and radiologists. Prospective registry PRAGUE-16. EuroIntervention. 2017;13:131–6. doi: 10.4244/EIJ-D-16-00979. PubMed DOI

Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41. doi: 10.1161/01.STR.24.1.35. PubMed DOI

Binning MJ, Bartolini B, Baxter B, Budzik R, English J, Gupta R, Hedayat H, Krajina A, Liebeskind D, Nogueira RG, Shields R, Veznedaroglu E. Trevo 2000: Results of a Large Real-World Registry for Stent Retriever for Acute Ischemic Stroke. J Am Heart Assoc. 2018;7:e010867. doi: 10.1161/JAHA.118.010867. PubMed DOI PMC

Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafé A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31. PubMed

Leigh R, Zaidat OO, Suri MF, Lynch G, Sundararajan S, Sunshine JL, Tarr R, Selman W, Landis DM, Suarez JI. Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. Stroke. 2004;35:1903–7. doi: 10.1161/01.STR.0000132571.77987.4c. PubMed DOI

Nogueira RG, Liebeskind DS, Sung G, Duckwiler G, Smith WS Multi MERCI Writing Committee. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials. Stroke. 2009;40:3777–83. PubMed

Kumar G, Shahripour RB, Alexandrov AV. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. J Neurointerv Surg. 2015;7:868–74. doi: 10.1136/neurintsurg-2014-011418. PubMed DOI

Linfante I, Starosciak AK, Walker GR, Dabus G, Castonguay AC, Gupta R, Sun CH, Martin C, Holloway WE, Mueller-Kronast N, English JD, Malisch TW, Marden FA, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Yoo AJ, Abou-Chebl A, Chen PR, Britz GW, Kaushal R, Nanda A, Issa MA, Nogueira RG, Zaidat OO. Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry. J Neurointerv Surg. 2016;8:224–9. doi: 10.1136/neurintsurg-2014-011525. PubMed DOI

Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82:2N–9N. doi: 10.1016/S0002-9149(98)00583-9. PubMed DOI

Gattellari M, Goumas C, Aitken R, Worthington JM. Outcomes for patients with ischaemic stroke and atrial fibrillation: the PRISM study (A Program of Research Informing Stroke Management). Cerebrovasc Dis. 2011;32:370–82. doi: 10.1159/000330637. PubMed DOI

Park KY, Kim YB, Chung PW, Moon HS, Suh BC, Yoon KJ, Lee YT. Right-side propensity of cardiogenic emboli in acute ischemic stroke with atrial fibrillation. Scand Cardiovasc J. 2014;48:335–8. doi: 10.3109/14017431.2014.983964. PubMed DOI

Hornung M, Bertog SC, Grunwald I, Sievert K, Sudholt P, Reinartz M, Vaskelyte L, Hofmann I, Sievert H. Acute Stroke Interventions Performed by Cardiologists: Initial Experience in a Single Center. JACC Cardiovasc Interv. 2019;12:1703–10. doi: 10.1016/j.jcin.2019.05.052. PubMed DOI

Abelson M, Roos J, Rymer M. Mechanical thrombo-embolectomy in acute ischaemic stroke: a local experience. Cardiovasc J Afr. 2008;19:204–7. PubMed

Goktekin O, Tasal A, Uyarel H, Vatankulu MA, Sönmez O, Kul S, Ay N, Yamac H, Altintas O, Karadeli H, Kolukisa M, Aralasmak A, Asil T. Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single center experience from Turkey. EuroIntervention. 2014;10:876–83. doi: 10.4244/EIJV10I7A149. PubMed DOI