title: Safety and Efficacy of Mechanical Thrombectomy in Acute Ischemic Stroke of Anticoagulated Patients-A Prospective Observational Study.
abstract: BACKGROUND
  Anticoagulated patients (APs) are excluded from the acute stroke management with alteplase in Europe, not in the United States. They could benefit from mechanical thrombectomy (MT), which was not undoubtedly proven. There are scarce data about its results in such patients. The authors' aim is to analyze the efficacy and safety of MT in APs presenting with an acute stroke in our institution.
  
  
  METHODS
  Prospective observational study comparing 30 APs and 109 non-anticoagulated patients (N-APs) underwent direct MT without alteplase. Demographic data, clinical severity (National Institutes of Health Stroke Scale [NIHSS]), efficacy (recanalization thrombolysis in cerebral infarction [TICI] ≥ 2b and modified Rankin Scale score ≤ 2 at 3 months), and security (symptomatic intracranial hemorrhage [SICH], mortality at 3 months) were compared between both groups.
  
  
  RESULTS
  In both groups men were more frequent (63.3% of APs were men and 61.5% of N-APs were men). Mean age was 73 in APs and 67.2 in N-APs. Median NIHSS was similar (17 APs; 16 N-APs), also TICI greater than or equal to 2b (93.3% APs; 89.9% N-APs). The 3-month modified Rankin Scale score less than or equal to 2 was 46.7% in APs and 55.2% in N-APs (P = .40). SICH was present in 16.7% of APs and 8.3% of N-APs (P = .15). Mortality at 3 months was 6.7% in APs and 19% in N-APs (P = .08).
  
  
  CONCLUSIONS
  MT is a valid treatment option in APs. It achieves an efficacy as in N-APs with a tendency to suffer more from SICH, but lower mortality. We hypothesize that cardioembolic clots may be easier to be removed than atherotrombotics, and that embolic stroke in APs might be less severe than that in N-APs or might suffer less of other complications than atherotrombotics.
authors.affiliation: Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. Electronic address: lbf.benfer@gmail.com.
authors.forename: Lorena
authors.initials: L
authors.lastname: Benavente
authors.affiliation: Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Davinia
authors.initials: D
authors.lastname: Larrosa
authors.affiliation: Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Cabo
authors.affiliation: Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Ángel I
authors.initials: ÁI
authors.lastname: Pérez
authors.affiliation: Neurology Department, Hospital de Cabueñes, Gijón, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rico
authors.affiliation: Radiology Department, Hospital Universitario Central de Asturias, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Vega
authors.affiliation: Radiology Department, Hospital Universitario Central de Asturias, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Murias
authors.affiliation: Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Calleja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; cerebrovascular disorders; revascularization; stroke; thrombolysis