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Natera-Villalba E, Cruz-Culebras A, García-Madrona S, Vera-Lechuga R, de Felipe-Mimbrera A, Matute-Lozano C, Gómez-López A, Ros-Castelló V, Sánchez-Sánchez A, Martínez-Poles J, Nedkova-Hristova V, Escribano-Paredes JB, García-Bermúdez I, Méndez J, Fandiño E, Masjuan J. Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital. Neurología (English Edition) 2021; 38:236-245. [PMID: 34092537 DOI: 10.1016/j.nrleng.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.
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Affiliation(s)
- E Natera-Villalba
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Cruz-Culebras
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S García-Madrona
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vera-Lechuga
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A de Felipe-Mimbrera
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Matute-Lozano
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Gómez-López
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Ros-Castelló
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Sánchez-Sánchez
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Martínez-Poles
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Nedkova-Hristova
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J B Escribano-Paredes
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I García-Bermúdez
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Méndez
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Fandiño
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Masjuan
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, Spain; Servicio de Neurología, Hospital Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
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Natera-Villalba E, Cruz-Culebras A, García-Madrona S, Vera-Lechuga R, de Felipe-Mimbrera A, Matute-Lozano C, Gómez-López A, Ros-Castelló V, Sánchez-Sánchez A, Martínez-Poles J, Nedkova-Hristova V, Escribano-Paredes JB, García-Bermúdez I, Méndez J, Fandiño E, Masjuan J. Mechanical thrombectomy beyond 6hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital. Neurologia 2021; 38:S0213-4853(20)30298-X. [PMID: 33551125 DOI: 10.1016/j.nrl.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Thrombectomy in the carotid artery territory was recently shown to be effective up to 24hours after symptoms onset. METHODS We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting>50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION In our experience, mechanical thrombectomy beyond 6hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24hours after onset merits study.
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Affiliation(s)
- E Natera-Villalba
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - A Cruz-Culebras
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - S García-Madrona
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vera-Lechuga
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A de Felipe-Mimbrera
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Matute-Lozano
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Gómez-López
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Ros-Castelló
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Sánchez-Sánchez
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Martínez-Poles
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Nedkova-Hristova
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J B Escribano-Paredes
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España
| | - I García-Bermúdez
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Méndez
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Fandiño
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Masjuan
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal, Madrid, España; Servicio de Neurología, Hospital Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España
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Rodríguez-Pardo J, Secades-García S, Riera-López N, Alonso de Leciñana M, Real-Martínez V, Carneado-Ruiz J, Díaz-Guzmán J, Díez-Tejedor E, Egido-Herrero J, Gil-Núñez A, Matute-Lozano MC, Trillo S, Vera-Lechuga R, Vivancos-Mora J, Ximénez-Carrillo Á, Fuentes B. Contraindications to intravenous thrombolysis in prehospital triage of thrombectomy candidates. Eur J Neurol 2020; 27:2439-2445. [PMID: 32638466 DOI: 10.1111/ene.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The existence of contraindications to intravenous thrombolysis (IVT) is considered a criterion for direct transfer of patients with suspected acute stroke to thrombectomy-capable centers in the prehospital setting. Our aim was to assess the utility of this criterion in a setting where routing protocols are defined by the Madrid - Direct Referral to Endovascular Center (M-DIRECT) prehospital scale. METHODS This was a post hoc analysis of the M-DIRECT study. Reported contraindications to IVT were retrospectively collected from emergency medical services reports and categorized into late window, anticoagulant treatment and other contraindications. Final diagnosis and treatment rates were compared between patients with and without reported IVT contraindications and according to anticoagulant treatment or late window categories. RESULTS The M-DIRECT study included 541 patients. Reported IVT contraindications were present in 227 (42.0%) patients. Regarding final diagnosis no significant differences were found between patients with or without reported IVT contraindications: ischaemic stroke (any) 65.6% vs. 62.1%, ischaemic stroke with large vessel occlusion (LVO) 32.2% vs. 28.3%, hemorrhagic stroke 15.4% vs. 15.6%, stroke mimic 18.9% vs. 22.3% respectively. Amongst patients with LVO, endovascular thrombectomy (EVT) was performed less often in the presence of IVT contraindications (56.2% vs. 74.2%). M-DIRECT-positive patients had higher rates of LVO and EVT compared with M-DIRECT-negative patients independent of reported IVT contraindications. CONCLUSIONS Reported IVT contraindications alone do not increase EVT likelihood and should not be considered to determine routing in urban stroke networks.
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Affiliation(s)
- J Rodríguez-Pardo
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Secades-García
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - N Riera-López
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - M Alonso de Leciñana
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - V Real-Martínez
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - J Carneado-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Díaz-Guzmán
- Department of Neurology, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - E Díez-Tejedor
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Egido-Herrero
- Department of Neurology, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - A Gil-Núñez
- Department of Neurology, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M C Matute-Lozano
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - S Trillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - R Vera-Lechuga
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - J Vivancos-Mora
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Á Ximénez-Carrillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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