دورية أكاديمية
Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients
| العنوان: | Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients |
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| المؤلفون: | L’Allinec, Vincent, Ernst, Marielle, Sevin-Allouet, Mathieu, Testard, Nathalie, Delasalle-Guyomarch, Béatrice, Guillon, Benoit, Mazighi, Mikael, Desal, Hubert, Bourcier, Romain, the NTF investigators, M, Roy, A, Gaultier, B, Daumas-Duport, O, Catar, A, Lecluse, S, Godard, M, Guillaume, A, Pasco, I, Lemoine, S, Ledure, F, Rouanet, I, Sibon, X, Barreau, J, Berge, P, Menegon, V, Dousset, B, Lamande, A, Ferrier, B, Jean, E, Chabert, J, Gabrillarges, N, Behechti, A, Kazemi, F, Ricolfi, M, Proust, F, Tahon, A, Vasdev, F, Boustia, E, Kalsoum, P, Aguettaz, X, Leclerc, S, Saleme, C, Mounayer, G, Gautier, H, Brunel, R, Tonnelet, R, Anxionnat, S, Bracard, M, Moynier, C, Riquelme, P, Machi, C, Arquizan, V, Costalat, A, Bonafe, G, Arnoult, L, Pierot, F, Kestens, T, Ronziere, JY, Gauvrit, AC, Januel, F, Bonneville, C, Cognard, C, Papagiannaki, R, Bibi, D, Herbreteau, O, Naggara, F, Puccinelli, B, Lapergue, O, Coskun, P, Guedin, G, Rodesch, H, Hosseini, T, Tuilier, S, Gallas, A, Gaston, H, Redjem, AS, Pellen, M, Abricard, R, Blanc, M, Piotin, B, Gory, R, Riva, F, Di Maria, N, Sourour, F, Clarencon, L, Blanchard, S, Velasco |
| بيانات النشر: | BMJ Publishing Group Ltd |
| سنة النشر: | 2018 |
| المجموعة: | HighWire Press (Stanford University) |
| مصطلحات موضوعية: | Ischemic Stroke |
| الوصف: | Background Anticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs. Methods We analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups. Results 333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups. Conclusions With regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group. |
| نوع الوثيقة: | text |
| وصف الملف: | text/html |
| اللغة: | English |
| العلاقة: | http://jnis.bmj.com/cgi/content/short/10/12/e29Test; http://dx.doi.org/10.1136/neurintsurg-2017-013714Test |
| DOI: | 10.1136/neurintsurg-2017-013714 |
| الإتاحة: | https://doi.org/10.1136/neurintsurg-2017-013714Test http://jnis.bmj.com/cgi/content/short/10/12/e29Test |
| حقوق: | Copyright (C) 2018, Society of NeuroInterventional Surgery |
| رقم الانضمام: | edsbas.16706891 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1136/neurintsurg-2017-013714 |
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