ROME — Direct catheter-based thrombectomy without IV thrombolysis was safe under the care of a team comprising cardiologists, neurologists, and radiologists, a registry-based study suggested.
Without tissue-type plasminogen activator (tPA), procedure-related complications of stent retrievers — subarachnoid hemorrhage, vessel perforation or dissection, symptomatic stent thrombosis within 24 hours, carotico-cavernous fistula, and traveling emboli — occurred at a 10% rate, reported Petr Widimsky, MD, of Charles University in Prague, Czech Republic, at the European Society of Cardiology annual meeting.
Symtomatic intracranial hemorrhages were reported in 12% of such cases.
“Direct catheter-based thrombectomy may be as similarly effective and safe as bridging thrombolysis, and may thus be considered in patients with contraindications for thrombolysis or in patients with very short CT–groin puncture times,” Widimsky said.
In 2015, his group reported similar results in a study of 84 consecutive patients. The new data are also in line with previous findings that endovascular therapy for stroke worked for patients regardless of their eligibility for tPA.
The PRAGUE-16 registry included 103 patients who received CT scans within 6 hours of stroke onset. They then proceeded to stent retriever therapy with or without intravenous tPA.
Overall, 41% of participants had a substantial neurological recovery within 90 days, achieving a score of 2 or below on the modified Rankin Scale. Between patients with isolated occlusions of the middle cerebral artery and those with basilar or vertebral occlusions, that figure was 59% and 25%, respectively.
Patients who underwent stent retriever therapy without intravenous tPA were numerically more likely to have a history of atrial fibrillation or stroke. It also took longer for them to get CT imaging after symptom onset; those who did get thrombolytics, on the other hand, had more time pass between the CT and groin puncture.
“Thrombolytics were given when patients came in the middle of the night and it took longer for the cardiologist to arrive,” Widimsky said.
There was a faster improvement in functional outcomes if patients underwent thrombectomy without thrombolytics (6.3 point reduction on NIH Stroke Scale at 24 hours versus 2.85 points for patients getting tPA plus stent retrieval), though Widimsky’s team did not perform any statistical analysis, so cautioned against making a comparison between the groups.
“A randomized trial is needed to confirm these hypothesis-generating results,” he stated.
Widimsky disclosed no relevant relationships with industry.
European Society of Cardiology
Widimsky P, et al “Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischemic stroke. Prospective registry PRAGUE-16” ESC 2016.