Mechanical Thrombectomy in Acute Ischemic Stroke—The Role of Interventional Cardiologists

• Published in: JACC. Cardiovascular interventions 2022-03, Vol.15 (5), p.550-558
• Main Authors: Wita, Krystian, Kułach, Andrzej, Wilkosz, Katarzyna, Wybraniec, Maciej, Wojakowski, Wojciech, Kuczmik, Wacław, Lelek, Michał, Tomalski, Witold, Ochała, Andrzej, Uchwat, Urszula, Lasek-Bal, Anetta
• Format: Article
• Language: English
• Subjects: catheter-based thrombectomy; interventional cardiology; mechanical thrombectomy; stroke
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2021.11.041

The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality. MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy. In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52). Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar. Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure. [Display omitted]