Acute stroke intervention by interventional cardiologists.
OBJECTIVE
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.
DeVries
James T
JT
Department of Cardiovascular Diseases, The Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
White
Christopher J
CJ
Collins
Tyrone J
TJ
Jenkins
J Stephen
JS
Reilly
John P
JP
Grise
Mark A
MA
McMullan
Paul W
PW
Badawi
Ramy A
RA
Ramee
Stephen R
SR
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D002309:Cardiology / Q000379:methods*; D002533:Cerebral Angiography; D003299:Cooperative Behavior; D004185:Disability Evaluation; D017128:Embolectomy; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009462:Neurology; D010348:Patient Care Team; D010561:Personnel Staffing and Scheduling; D015641:Radiography, Interventional; D015642:Radiology, Interventional / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome