A catheter-based thrombectomy program initiated in an experienced cardiac catheterization laboratory with close cooperation among cardiologists, neurologists and radiologists can yield outcomes comparable to those of established neuroradiology centers, according to results released Monday from the PRAGUE-16 study.
The treatment of acute ischemic stroke now includes mechanical thrombectomy. This treatment, however, is limited to highly specialized centers with experienced neurointerventionalists. For those without these capabilities, options remain limited.
Jakub Sulzenko, MD, PhD, of Charles University and University Hospital Kralovske Vinohrady, Prague, and co-investigators, sought to analyze the learning curve after starting a new stroke thrombectomy program in a cardiac catheterization lab in close cooperation with neurologists and radiologists. They reported their results in a manuscript published in the April 12 issue of JACC: Cardiovascular Interventions.
In 2012, an endovascular treatment was established in the cardiac catheterization laboratory of their tertiary hospital. Catheter-based thrombectomy was performed if referred by a neurologist. Patients with large-vessel occlusion of the anterior or posterior circulation were enrolled. The primary endpoint was functional neurological outcome determined by the Modified Rankin Scale (mRS) score at 3 months.
From 2012 through 2019, a total of 333 patients were enrolled. Patients' mRS did not significantly vary across the years of treatment (mRS 0-2 in 47.9% of patients). Only 5.7% (19/333) of patients suffered intracerebral hemorrhage, and just 1.8% (6/333) of patients experienced embolization in a new vascular territory.
Marius Hornung, MD, and Horst Sievert, MD, of CardioVascular Center Frankfurt, Frankfurt, Germany, wrote an accompanying editorial to the study. In it, they acknowledged the unmet need for wide availability of mechanical thrombectomy for the treatment of acute ischemic stroke. A universally available short-term solution could be to use interventional cardiologists and the vast network of cardiac catheterization laboratories. They applaud the PRAGUE-16 study for demonstrating how a network can succeed with support from multiple departments, setting aside pride, in order to provide the best care possible to patients.
Sulženko J, Kožnar B, Peisker T, et al. Stable Clinical Outcomes When a Stroke Thrombectomy Program Is Started in an Experienced Cardiology Cath Lab. JACC Cardiovasc Interv 2021;14:785–92.
Hornung M, Sievert H. It Is Time to Fight Ischemic Stroke the Best Possible Way. JACC Cardiovasc Interv 2021;14:793–5.