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Acute stroke intervention by interventional cardiologists
Author(s) -
DeVries James T.,
White Christopher J.,
Collins Tyrone J.,
Jenkins J. Stephen,
Reilly John P.,
Grise Mark A.,
McMullan Paul W.,
Badawi Ramy A.,
Ramee Stephen R.
Publication year - 2009
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21927
Subject(s) - medicine , thrombolysis , stroke (engine) , intracerebral hemorrhage , modified rankin scale , adverse effect , emergency medicine , culprit , emergency department , ischemic stroke , subarachnoid hemorrhage , myocardial infarction , ischemia , mechanical engineering , psychiatry , engineering
Objectives: To report the technical success and clinical outcomes of catheter‐based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. Background: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. Methods: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. Results: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful “culprit” artery recanalization was achieved in 23 (88%) of the 26 patients. In‐hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 ± 9.9 (median 16) and improved significantly to 9.9 ± 8.7 (median 9) ( P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half ( n = 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). Conclusions: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. © 2008 Wiley‐Liss, Inc.