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Multicenter Study
. 2020 Nov;96(6):1296-1303.
doi: 10.1002/ccd.29180. Epub 2020 Aug 10.

Outcomes following endovascular therapy for acute stroke by interventional cardiologists

Tamunoinemi Bob-Manuel  1   2 , Marius Hornung  3 , Steven Guidera  4 , Marloe Prince  1   2 , Antonio Duran  1   2 , Horst Sievert  3   5 , Stefan Bertog  3   5 , Iris Grunwald  3   5 , Christopher J White  1   2
Affiliations
Multicenter Study

Outcomes following endovascular therapy for acute stroke by interventional cardiologists

Tamunoinemi Bob-Manuel et al. Catheter Cardiovasc Interv. 2020 Nov.

Abstract

Objectives: To summarize the outcomes of acute ischemic stroke (AIS) intervention by interventional cardiologists (IC) working on a stroke team.

Background: There is a geographic maldistribution of dedicated neuro-interventionalists (NI) to treat large vessel occlusion (LVO) AIS.

Methods: Results of 166 consecutive patients who received endovascular therapy (EVT) for AIS due to LVO by IC at three centers between 2009 and 2019 are reported. A modified Rankin score (mRs) of ≤ 2 at 90 days after EVT was used as the primary measurement of a good neurological outcome. Univariate logistic regression was used to evaluate predictors of the mRS > 2 and mortality. Those variables with significance of p < .2 from the univariate analysis were included in a multivariate analysis.

Results: All-cause mortality at 30 days was 22%. A favorable clinical outcome, mRS ≤ 2 at 90 days, was 49%. After multivariate analysis and controlling for confounders, a higher baseline NIHSS was predictive of 30-day mortality (OR 1.20 [95% CI 1.09-1.32] p < .001) and unfavorable clinical outcome (mRS > 2) at 90 days (OR 1.16 [95% CI 1.07-1.25] p < .001).

Conclusion: Outcomes for carotid stent capable IC performing EVT for AIS are comparable to those achieved by NI physicians in major randomized clinical trials. Our data supports conducting a clinical trial of carotid stent capable IC working on multidisciplinary stroke teams to perform EVT for AIS due to LVO in communities and hospitals without timely access (<60 min by ground transport) to dedicated NI.

Keywords: endovascular therapy; geographic disparity; neuro-intervention.

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Comment in

  • A no-brainer.
    Butler RM, Gray WA. Butler RM, et al. Catheter Cardiovasc Interv. 2020 Nov;96(6):1304-1305. doi: 10.1002/ccd.29360. Catheter Cardiovasc Interv. 2020. PMID: 33217187

References

REFERENCES

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