title: Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischaemic stroke. Cooperation among cardiologists, neurologists and radiologists. Prospective registry PRAGUE-16.
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology centre.
  
  
  RESULTS
  This single-centre, prospective observational registry based on the pre-specified protocol included three months of follow-up. The decision to perform acute stroke intervention was made by a neurologist based on the clinical and imaging findings. Inclusion criteria were moderate-to-severe acute ischaemic stroke (NIHSS ≥6), <6 hours from symptom onset, no large ischaemia on the admission CT scan and CT evidence for an occluded large artery. The primary outcome was functional neurologic recovery (mRS 0-2) at three months. Key secondary outcomes were the angiographic recanalisation rate and symptomatic intracranial bleeding. A total of 115 consecutive patients (mean age 66 years) were enrolled during a period of four years: 84 patients underwent d-CBT and 31 patients bridging thrombolysis with immediate catheter intervention (TL-CBT). The annual number of procedures increased from 13 (initial 12 months) to 41 (last 12 months). Angiographic success (TICI flow 2b-3) was 69% after d-CBT and 81% after TL-CBT. It was higher in isolated occlusions of the middle cerebral artery (MCA, 74% and 100%) or of the proximal internal carotid artery (ICA, 80% and 100%), while it was lower in combined ICA+MCA occlusions (63% and 70%) and in basilar or vertebral occlusions (57% and 50%). Neurologic recovery (mRS ≤2 after 90 days) was achieved in 40% of patients. It was higher (43%) in anterior circulation strokes than in posterior circulation strokes (25%). Direct CBT led to neurologic recovery in 36%, while in TL-CBT this was 52%. Best clinical outcomes (51% and 71% neurologic recovery rates) were achieved among patients with isolated MCA occlusion. Any symptomatic intracranial bleeding was present in 3.6% (d-CBT) and 6.5% (TL-CBT). Vessel perforation or major dissection occurred in 5.2% overall, and distal embolisation to other territory in 3.5% of patients.
  
  
  CONCLUSIONS
  Direct catheter-based thrombectomy may be considered in patients with contraindications for thrombolysis or in patients with very short CT-groin puncture times. A randomised trial is needed to evaluate better the role of direct catheter-based thrombectomy. Acute stroke interventions performed in close cooperation among cardiologists, neurologists and radiologists are feasible and safe.
authors.affiliation: Charles University, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Boris
authors.initials: B
authors.lastname: Koznar
authors.forename: Tomas
authors.initials: T
authors.lastname: Peisker
authors.forename: Peter
authors.initials: P
authors.lastname: Vasko
authors.forename: Filip
authors.initials: F
authors.lastname: Rohac
authors.forename: Jana
authors.initials: J
authors.lastname: Vavrova
authors.forename: Josef
authors.initials: J
authors.lastname: Kroupa
authors.forename: Ivana
authors.initials: I
authors.lastname: Stetkarova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072096:Cardiologists; D002343:Carotid Artery, Internal / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072141:Neurologists; D010348:Patient Care Team; D011446:Prospective Studies; D000072177:Radiologists; D012042:Registries; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D016896:Treatment Outcome