Acute stroke intervention by interventional cardiologists

Abstract

Objectives: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. Background: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. Methods: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. Results: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful ' 'culprit' ' artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 6 9.9 (median 16) and improved significantly to 9.9 6 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n 5 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). Conclusions: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. '

Trends, Predictors, and Outcomes of Cerebrovascular Events Related to Percutaneous Coronary Intervention

“…Moreover, projected increases in the use of structural interventions such as transcutaneous aortic valve replacement might further increase rates of CVE related to cardiac catheter-based procedures. The current study, indicating adverse short-and long-term outcomes after such complications, underscores the importance of developing risk scores to identify groups at higher risk in advance to facilitate timely implementation of treatment measures such as early fibrinolysis (12) or acute neuro-endovascular intervention when appropriate (13). Study limitations.…”

Editorial: Workforce needs for endovascular acute ischemic stroke therapy: myth or reality?

“…1 The rapid evolution of intraarterial therapy for ischemic stroke has led to speculation regarding the availability of a sufficient number of operators to treat patients in the United States (US). 14,15,37,38 Stroke is the fourth leading cause of death in the US, after heart disease, cancer, and lung disease, 32 so it is tempting to speculate that the number of neurointerventions for stroke must be headed for rapid expansion.…”

“…Analysis of the neurointerventional workforce has been conducted for more than a decade, with initial work on this subject estimating that the optimal number of neurointerventionalists might be 600 in the US. 12 While several papers in the cardiology literature have claimed that a shortage of neurointerventionalists would require cardiologists to provide endovascular therapy for acute ischemic stroke, 14,15,37 there is actually no evidence that such a shortage exists. The number of neurointerventionalists was noted to be approaching 800 in 2012, 16,41 and with 80-100 fellows finishing training each year recently, 16 the number continues to grow.…”

The stroke interventionalist

“…However, some of the articles touting the readiness of interventional cardiologists to offer endovascular stroke therapy bring to mind the Dunning–Kruger effect 3 4. Described by David Dunning and Justin Kruger in 1999, it is a cognitive bias that leads people to overestimate their abilities.…”