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Cherian J, Cronkite C, Srinivasan V, Haider M, Haider AS, Kan P, Johnson JN. Mechanical thrombectomy for acute stroke complicating cardiac interventions. Brain Circ 2021; 7:265-270. [PMID: 35071843 PMCID: PMC8757505 DOI: 10.4103/bc.bc_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION: Acute ischemic stroke (AIS) complicating cardiac interventions (CI) is well described. The use of mechanical thrombectomy (MT) for treatment of emergent large vessel occlusion (ELVO) in this setting, however, is not widely reported. METHODS: Cases of patients undergoing MT for AIS with ELVO at a single institution were reviewed. Cases preceded by recent CI were investigated retrospectively. Data was collected for patient demographics, type of cardiac intervention, stroke characteristics, neurovascular intervention, and patient outcomes. RESULTS: Between 2008 and 2017, registry analysis identified nine patients treated with MT for AIS complicating recent CI. Patients were more commonly male with a mean age of 67 years. A large majority had a known cardiac arrhythmia. Coronary artery bypass graft surgery (CABG) was the most identified CI, followed by valve repair, and cardiac ablations. Mean presenting NIHSS was 18. Most presented with hemiplegia. Seven cases were found to have MCA occlusions. Stent-retrievers were used in 6 cases with excellent recanalization in five MCA cases (TICI 2c or 3) and in two basilar cases. Despite immediate improvements in NIHSS scores in most cases, functional outcomes were poor in 7 cases (mRS of 4-6). Three cases were complicated by hemorrhage and three cases ended in mortality. CONCLUSION: AIS with ELVO following recent CI is associated with high rates of mortality and poor functional outcomes despite MT. Further work is needed to understand the key drivers to poor outcomes in this ELVO subgroup.
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Affiliation(s)
- Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Visish Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maryam Haider
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Ali S Haider
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Werner N, Bauer T, Hochadel M, Zahn R, Weidinger F, Marco J, Hamm C, Gitt AK, Zeymer U. Incidence and Clinical Impact of Stroke Complicating Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2013; 6:362-9. [DOI: 10.1161/circinterventions.112.000170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Stroke is a rare but serious complication of percutaneous coronary interventions (PCIs). So far, scant information is available about the incidence and outcome of patients developing stroke after PCI for stable angina or acute coronary syndrome (ACS) in daily clinical practice in Europe today.
Methods and Results—
Between 2005 and 2008, 46 888 patients undergoing PCI were enrolled into the PCI Registry of the Euro Heart Survey Programme (176 centers in 33 European countries) to document patient’s characteristics, PCI details, and hospital complications in different PCI indications. Stroke was observed in 0.4% of the procedures in the total population, in 0.3% of PCIs in elective patients, and in 0.6% in PCIs performed for ACS. The overall in-hospital mortality was 19.2% for patients who developed stroke (elective PCIs, 10.0%; PCI for ACS, 23.2%) compared with 1.3% for those without stroke (elective PCIs, 0.2%; PCI for ACS, 2.3%). In multivariate analysis hemodynamic instability, age ≥75 years, history of stroke, and congestive heart failure were found to be independent predictors for periprocedural stroke in ACS, whereas only PCI of a bypass graft and renal failure could be identified as independent predictors for stroke in elective patients.
Conclusions—
Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, peri-interventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research.
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Affiliation(s)
- Nicolas Werner
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Timm Bauer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Matthias Hochadel
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ralf Zahn
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Franz Weidinger
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jean Marco
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Christian Hamm
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Anselm K. Gitt
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Uwe Zeymer
- From the Herzzentrum, Kardiologie, Städtisches Klinikum, Ludwigshafen, Germany (N.W., T.B., R.Z.); Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany (A.K.G., U.Z.); Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany (M.H., A.K.G., U.Z.); Medizinische Abteilung der Krankenanstalt Rudolfstiftung, Wien, Austria (F.W.); Centre Cardio-Thoracique de Monaco, Monte Carlo, Monaco (J.M.); and Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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