Mechanical thrombectomy outcomes in large vessel stroke with high international normalized ratio

Abhi Pandhi, Georgios Tsivgoulis, Muhammad F. Ishfaq, Aristeidis Katsanos, Georgios Magoufis, Konark Malhotra, Rashi Krishnan, Adam Arthur, Daniel Hoit, Lucas Elijovich, Andrei Alexandrov, Ahmad Cheema, Nitin Goyal

Research output: Contribution to journalArticle

Abstract

Objective: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute stroke patients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). Methods: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0–2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. Results: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14–22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12–21)]. Patients with high INR did not differ in terms of sICH (10.0% vs. 6.9%; p =.706), 3-month mortality (20.0% vs. 24.2%; p =.762), SR (88.9% vs. 69.4%; p =.209) and 3-month FI (50% vs. 49.3%; p =.762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95%CI: 0.42–2.07; p =.88), 3-month mortality (OR: 1.07, 95%CI: CI 0.72–1.60; p =.73) and 3-month FI (OR: 0.69, 95%CI: 0.34–1.40; p =.30). Conclusions: MT can be performed safely and effectively in ELVO patients with high INR.

Original languageEnglish (US)
Pages (from-to)193-198
Number of pages6
JournalJournal of the Neurological Sciences
Volume396
DOIs
StatePublished - Jan 15 2019

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Thrombectomy
International Normalized Ratio
Stroke
Intracranial Hemorrhages
Reperfusion
Meta-Analysis
Mortality
Safety
Cohort Studies
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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Mechanical thrombectomy outcomes in large vessel stroke with high international normalized ratio. / Pandhi, Abhi; Tsivgoulis, Georgios; Ishfaq, Muhammad F.; Katsanos, Aristeidis; Magoufis, Georgios; Malhotra, Konark; Krishnan, Rashi; Arthur, Adam; Hoit, Daniel; Elijovich, Lucas; Alexandrov, Andrei; Cheema, Ahmad; Goyal, Nitin.

In: Journal of the Neurological Sciences, Vol. 396, 15.01.2019, p. 193-198.

Research output: Contribution to journalArticle

Pandhi, Abhi ; Tsivgoulis, Georgios ; Ishfaq, Muhammad F. ; Katsanos, Aristeidis ; Magoufis, Georgios ; Malhotra, Konark ; Krishnan, Rashi ; Arthur, Adam ; Hoit, Daniel ; Elijovich, Lucas ; Alexandrov, Andrei ; Cheema, Ahmad ; Goyal, Nitin. / Mechanical thrombectomy outcomes in large vessel stroke with high international normalized ratio. In: Journal of the Neurological Sciences. 2019 ; Vol. 396. pp. 193-198.
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abstract = "Objective: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute stroke patients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). Methods: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0–2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. Results: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14–22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12–21)]. Patients with high INR did not differ in terms of sICH (10.0{\%} vs. 6.9{\%}; p =.706), 3-month mortality (20.0{\%} vs. 24.2{\%}; p =.762), SR (88.9{\%} vs. 69.4{\%}; p =.209) and 3-month FI (50{\%} vs. 49.3{\%}; p =.762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95{\%}CI: 0.42–2.07; p =.88), 3-month mortality (OR: 1.07, 95{\%}CI: CI 0.72–1.60; p =.73) and 3-month FI (OR: 0.69, 95{\%}CI: 0.34–1.40; p =.30). Conclusions: MT can be performed safely and effectively in ELVO patients with high INR.",
author = "Abhi Pandhi and Georgios Tsivgoulis and Ishfaq, {Muhammad F.} and Aristeidis Katsanos and Georgios Magoufis and Konark Malhotra and Rashi Krishnan and Adam Arthur and Daniel Hoit and Lucas Elijovich and Andrei Alexandrov and Ahmad Cheema and Nitin Goyal",
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T1 - Mechanical thrombectomy outcomes in large vessel stroke with high international normalized ratio

AU - Pandhi, Abhi

AU - Tsivgoulis, Georgios

AU - Ishfaq, Muhammad F.

AU - Katsanos, Aristeidis

AU - Magoufis, Georgios

AU - Malhotra, Konark

AU - Krishnan, Rashi

AU - Arthur, Adam

AU - Hoit, Daniel

AU - Elijovich, Lucas

AU - Alexandrov, Andrei

AU - Cheema, Ahmad

AU - Goyal, Nitin

PY - 2019/1/15

Y1 - 2019/1/15

N2 - Objective: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute stroke patients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). Methods: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0–2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. Results: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14–22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12–21)]. Patients with high INR did not differ in terms of sICH (10.0% vs. 6.9%; p =.706), 3-month mortality (20.0% vs. 24.2%; p =.762), SR (88.9% vs. 69.4%; p =.209) and 3-month FI (50% vs. 49.3%; p =.762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95%CI: 0.42–2.07; p =.88), 3-month mortality (OR: 1.07, 95%CI: CI 0.72–1.60; p =.73) and 3-month FI (OR: 0.69, 95%CI: 0.34–1.40; p =.30). Conclusions: MT can be performed safely and effectively in ELVO patients with high INR.

AB - Objective: Evaluating the safety and efficacy of mechanical thrombectomy (MT) in acute stroke patients due to emergent large vessel occlusion (ELVO) with high international-normalized-ratio (INR). Methods: Consecutive ELVO patients treated with MT were evaluated from two centers. Outcome measures included symptomatic-intracranial-hemorrhage(sICH), three-month mortality, successful reperfusion(SR), and 3-month functional-independence(FI; mRS-scores of 0–2). Additionally, a meta-analysis of available cohort studies was performed to evaluate safety and efficacy of MT in ELVO patients with high INR. Results: A total of 315 ELVO patients were evaluated. Of those 10 patients had INR >1.7 [mean age 63.5 ± 15, median NIHSS-score: 17 points (IQR 14–22)],and remaining 305 ELVO patients had INR ≤ 1.7 ([mean age 62 ± 14.4, median NIHSS-score: 17 points (IQR 12–21)]. Patients with high INR did not differ in terms of sICH (10.0% vs. 6.9%; p =.706), 3-month mortality (20.0% vs. 24.2%; p =.762), SR (88.9% vs. 69.4%; p =.209) and 3-month FI (50% vs. 49.3%; p =.762) compared to the rest. Meta-analysis of available studies (n = 5) showed that high INR was not related to sICH (OR: 0.94, 95%CI: 0.42–2.07; p =.88), 3-month mortality (OR: 1.07, 95%CI: CI 0.72–1.60; p =.73) and 3-month FI (OR: 0.69, 95%CI: 0.34–1.40; p =.30). Conclusions: MT can be performed safely and effectively in ELVO patients with high INR.

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