title: Long-term safety and effectiveness of inferior vena cava filters in patients with stroke.
abstract: OBJECTIVE
  To assess the long-term safety and clinical effectiveness of inferior vena cava (IVC) filters in patients with stroke.
  
  
  METHODS
  In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, we reviewed the clinical data of patients who had stroke and were treated with an IVC filter from 2002 to 2009. The demographics, clinical data, indications for IVC filter, procedural complications, symptomatic post-filter pulmonary embolism (PE) and deep vein thrombosis (DVT), caval occlusion and incidental, imaging-evident filter-related complications were recorded. Safety was assessed through occurrence of filter-related complications during placement and follow-up. Effectiveness was assessed through occurrence of post-filter fatal and non-fatal PE.
  
  
  RESULTS
  During this period, 371 patients (224 male; mean age 67.5 years) with stroke received an IVC filter. The stroke was hemorrhagic in 28%, ischemic in 20%, associated with intracranial malignancy in 21% and trauma in 31%. 235 (63%) patients (PE in 159) had venous thromboembolism on imaging. The indications for IVC filter included contraindication to anticoagulation in 251 (68%), prophylaxis in 83 (22%), added protection in 22 (6%) and complication or failure of anticoagulation in 15 (4%). There was one procedural complication. During a follow-up of 1.74±2.36 years, 180 (49%) patients died, three due to post-filter PE and the remainder all due to primary disease. Symptomatic post-filter PE and DVT occurred at a frequency of 15% (54/371) and 16% (60/371), respectively. Of these, 15 (4%) had imaging-proven PE. Three (0.8%) succumbed to post-filter PE. Imaging-proven new or recurrent DVT occurred in 6% and 8%, respectively. Symptomatic caval occlusion was seen in five (5/371, 1.3%).
  
  
  CONCLUSIONS
  IVC filters have an acceptable safety profile in stroke patients. In our cohort, they were effective in preventing life-threatening PE.
authors: Department of Imaging, Massachusetts General Hospital, Boston, MA, USA.
authors: Bhanusupriya
authors: B
authors: Somarouthu
authors: Kalpana
authors: K
authors: Yeddula
authors: Stephan
authors: S
authors: Wicky
authors: Joshua A
authors: JA
authors: Hirsch
authors: Sanjeeva P
authors: SP
authors: Kalva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult