Premium
Outcomes following endovascular therapy for acute stroke by interventional cardiologists
Author(s) -
BobManuel Tamunoinemi,
Hornung Marius,
Guidera Steven,
Prince Marloe,
Duran Antonio,
Sievert Horst,
Bertog Stefan,
Grunwald Iris,
White Christopher J.
Publication year - 2020
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.29180
Subject(s) - medicine , stroke (engine) , univariate analysis , confounding , logistic regression , carotid stenting , randomized controlled trial , clinical trial , interventional cardiology , stent , multivariate analysis , emergency medicine , carotid arteries , mechanical engineering , carotid endarterectomy , engineering
Objectives To summarize the outcomes of acute ischemic stroke (AIS) intervention by interventional cardiologists (IC) working on a stroke team. Background There is a geographic maldistribution of dedicated neuro‐interventionalists (NI) to treat large vessel occlusion (LVO) AIS. Methods Results of 166 consecutive patients who received endovascular therapy (EVT) for AIS due to LVO by IC at three centers between 2009 and 2019 are reported. A modified Rankin score (mRs) of ≤ 2 at 90 days after EVT was used as the primary measurement of a good neurological outcome. Univariate logistic regression was used to evaluate predictors of the mRS > 2 and mortality. Those variables with significance of p < .2 from the univariate analysis were included in a multivariate analysis. Results All‐cause mortality at 30 days was 22%. A favorable clinical outcome, mRS ≤ 2 at 90 days, was 49%. After multivariate analysis and controlling for confounders, a higher baseline NIHSS was predictive of 30‐day mortality (OR 1.20 [95% CI 1.09–1.32] p < .001) and unfavorable clinical outcome (mRS > 2) at 90 days (OR 1.16 [95% CI 1.07–1.25] p < .001). Conclusion Outcomes for carotid stent capable IC performing EVT for AIS are comparable to those achieved by NI physicians in major randomized clinical trials. Our data supports conducting a clinical trial of carotid stent capable IC working on multidisciplinary stroke teams to perform EVT for AIS due to LVO in communities and hospitals without timely access (<60 min by ground transport) to dedicated NI.