Multicenter Study

. 2024 Dec;9(4):896-906.

doi: 10.1177/23969873241249295. Epub 2024 May 10.

Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

Hamza Salim^{1

2}, Basel Musmar³, Nimer Adeeb⁴, Vivek Yedavalli¹, Dhairya Lakhani¹, Sahibjot Singh Grewal⁵, Kareem El Naamani³, Nils Henninger⁶, Sri Hari Sundararajan⁷, Anna Luisa Kühn⁸, Jane Khalife⁹, Sherief Ghozy¹⁰, Luca Scarcia¹¹, Benjamin Yq Tan^{12

13}, Robert W Regenhardt², Jeremy J Heit¹⁴, Nicole M Cancelliere⁵, Joshua D Bernstock¹⁵, Aymeric Rouchaud¹⁶, Jens Fiehler¹⁷, Sunil Sheth¹⁸, Ajit S Puri⁸, Christian Dyzmann¹⁹, Marco Colasurdo²⁰, Xavier Barreau²¹, Leonardo Renieri²², João Pedro Filipe²³, Pablo Harker²⁴, Răzvan Alexandru Radu²⁵, Mohamad Abdalkader²⁶, Piers Klein²⁶, Thomas R Marotta⁵, Julian Spears⁵, Takahiro Ota²⁷, Ashkan Mowla²⁸, Pascal Jabbour³, Arundhati Biswas²⁹, Frédéric Clarençon³⁰, James E Siegler⁹, Thanh N Nguyen²⁶, Ricardo Varela³¹, Amanda Baker³², Muhammed Amir Essibayi³², David Altschul³², Nestor R Gonzalez³³, Markus A Möhlenbruch³⁴, Vincent Costalat²⁵, Benjamin Gory^{35

36}, Christian Paul Stracke³⁷, Mohammad Ali Aziz-Sultan¹⁵, Constantin Hecker³⁸, Hamza Shaikh⁹, David S Liebeskind³⁹, Alessandro Pedicelli⁴⁰, Andrea M Alexandre⁴⁰, Illario Tancredi⁴¹, Tobias D Faizy⁴², Erwah Kalsoum¹¹, Boris Lubicz⁴³, Aman B Patel², Vitor Mendes Pereira⁵, Adrien Guenego⁴³, Adam A Dmytriw^{2

5}; MAD MT Investigators

Collaborators, Affiliations

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
² Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
⁶ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁷ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁸ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
⁹ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
¹⁰ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹² Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹³ Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹⁴ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁵ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA.
¹⁶ Neuroradiology Department, Dupuytren, University Hospital of Limoges, Université de Limoges, Limoges, France.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²¹ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²² Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²³ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁴ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁵ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
²⁶ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
²⁷ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁸ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Suite, Los Angeles, CA, USA.
²⁹ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³⁰ Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University. Paris VI, France.
³¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³² Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³³ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³⁴ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁵ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁶ INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France.
³⁷ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Germany.
³⁸ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Austria.
³⁹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.
⁴⁰ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy.
⁴¹ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴² Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany.
⁴³ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 38726983
PMCID: PMC11569456
DOI: 10.1177/23969873241249295

Multicenter Study

Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

Hamza Salim et al. Eur Stroke J. 2024 Dec.

. 2024 Dec;9(4):896-906.

doi: 10.1177/23969873241249295. Epub 2024 May 10.

Authors

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
² Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
⁶ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁷ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁸ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
⁹ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
¹⁰ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹² Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹³ Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹⁴ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁵ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA.
¹⁶ Neuroradiology Department, Dupuytren, University Hospital of Limoges, Université de Limoges, Limoges, France.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²¹ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²² Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²³ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁴ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁵ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
²⁶ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
²⁷ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁸ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Suite, Los Angeles, CA, USA.
²⁹ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³⁰ Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University. Paris VI, France.
³¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³² Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³³ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³⁴ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁵ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁶ INSERM U1254, IADI, Université de Lorraine, Vandoeuvre-les-Nancy, France.
³⁷ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Germany.
³⁸ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Austria.
³⁹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.
⁴⁰ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy.
⁴¹ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴² Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany.
⁴³ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 38726983
PMCID: PMC11569456
DOI: 10.1177/23969873241249295

Abstract

Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.

Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications.

Results: Of the patients, 223 (34%) were on anticoagulation therapy. Anticoagulated patients were older (median age 78 vs 74 years; p < 0.001) and had a higher prevalence of atrial fibrillation (77% vs 26%; p < 0.001). Their baseline National Institutes of Health Stroke Scale (NIHSS) scores were also higher (median 12 vs 9; p = 0.002). Before propensity score matching (PSM), anticoagulated patients had similar rates of favorable 90-day outcomes (mRS 0-1: 30% vs 37%, p = 0.1; mRS 0-2: 47% vs 50%, p = 0.41) but higher mortality (26% vs 17%, p = 0.008). After PSM, there were no significant differences in outcomes between the two groups.

Conclusion: Anticoagulated patients undergoing MT for AIS due to DMVO did not show significant differences in 90-day mRS outcomes, reperfusion, or hemorrhage compared to non-anticoagulated patients after adjustment for covariates.

Keywords: Stroke; anticoagulation; thrombectomy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation.Dr. Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work.Dr. Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading) and Artedrone (Board); all not directly related to the present work.Dr. Henninger received support from W81XWH-19-PRARP-RPA form the CDMRP/DoD, NS131756 and U24NS113844 from the NINDS, and NR020231 from the NINR and received compensation from Myrobalan, Inc. and General Dynamics during the conduct of this study unrelated to this work.Dr. Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical.Dr. Yeo reports Advisory work for AstraZeneca, Substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro and Sunbird Bio, with equity in Ceroflo. All unrelated to the present work.Dr. Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra.Dr. Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson and Phenox (paid lectures), all not directly related to the present work.Dr. Puri is a consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical, he received research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular, and holds stocks in InNeuroCo, Agile, Perfuze, Galaxy and NTI.Dr. Tjoumakaris is a consultant for Medtronic and Microvention (funds paid to institution, not personally).Dr. Jabbour is a consultant for Medtronic, Microvention and Cerus.

Figures

**Figure 1.**
Bar charts display the percentage distribution of 90-day modified Rankin Scale (mRS) scores for stroke patients.

See this image and copyright information in PMC

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Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

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Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke

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Abstract

Conflict of interest statement

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