Endovascular Acute Stroke Treatment Performed by Vascular Interventional Radiologists: Is It Safe and Efficacious?
ABSTRACT To evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by a team of vascular interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists and to compare the results with those of previous reports from centres with specialised interventional neuroradiologists.
A total of 39 patients with acute ischemic stroke due to large-vessel occlusion not responding to or not eligible for intravenous thrombolysis were treated with either intra-arterial thrombolysis or mechanical thrombectomy (Penumbra System or solitaire FR thrombectomy system, respectively) and included in our prospective study. Outcomes were measured using the modified Rankin scale after 90 days, and recanalization was assessed by thrombolysis using the myocardial infarction score.
Mean patient age was 68.3 ± 14.2 years; the average National Institutes of Health Stroke Scale score at hospital admission was 17.2 (SD = 6.2 [n = 38]). Successful recanalization was achieved in 74.4 % of patients. Median time from clinical onset to recanalization was 5 h 11 min. Procedure-related complications occurred in 5 % of patients, and 7.5 % had a symptomatic intracerebral hemorrhage. Of the patients, 22.5 % died within the first 90 postprocedural days, 5 % of these from cerebral causes. Patients who were successfully recanalized had a clinical better outcome at follow-up than those in whom treatment failed. Of the patients, 35.9 % had an mRS score ≤2 after 90 days.
Our results are in line with those in the published literature and show that a treatment strategy with general interventional radiologists performing neurointerventional procedures in acute stroke patients with large vessel occlusions can be achieved to the benefit of patients.
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ABSTRACT: PURPOSE: Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. METHODS: Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high age and evaluated the scores in respect of technical efficacy. RESULTS: Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. CONCLUSIONS: Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged ≥80 years.CardioVascular and Interventional Radiology 05/2013; 36(5). DOI:10.1007/s00270-013-0636-9 · 1.97 Impact Factor
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ABSTRACT: To the Editor, We would like to congratulate the authors to their endovascular approach and their excellent technical and clinical results. Their study confirms that trained general interventional radiologists in close multidisciplinary cooperation can perform state-of-the-art endovascular acute stroke treatment (EVT).Traditionally, EVT is performed by subspecialized interventional neuroradiologists. Yet this organization, implying that the procedure is only performed in a few centralized and highly specialized stroke centers, has eminent logistic challenges. The most obvious is that with this organization only a few centers are able to offer this treatment.Yet EVT service should undoubtedly be organized in a way that the service is accessible in a 24/7 way, ensuring treatment possibility throughout the year without unnecessary long transportation times. However, because the lack of interventional neuroradiologists seems to be global, additional manpower is needed to provide this serviCardioVascular and Interventional Radiology 02/2014; 37(5). DOI:10.1007/s00270-014-0863-8 · 1.97 Impact Factor
- CardioVascular and Interventional Radiology 03/2014; 37(5). DOI:10.1007/s00270-014-0860-y · 1.97 Impact Factor