Technical success of acute stroke interventions performed by cardiologists - single center experience

BACKGROUND The aim of this study was to evaluate the technical success of acute stroke interventions performed in our interventional cardiology center.

METHODS Between July 2012 and February 2018 62 patients were referred to our center for acute stroke treatment caused by an occlusion on an extra- (1 vertebral, 16 carotid arteries) or intracranial artery (4 basilar cases). Fifteen patients (24%) had multiple vessel occlusions. Mean patient age was 72 years and 37 of them were male (59%). The majority of patients (n=48; 77%) were admitted via our local stroke unit, 8 patients (13%) were sent from other regional hospitals (including 9 wake-up strokes, 14%). Six patients (10%) had an acute stroke complicating another cardiovascular intervention.

RESULTS The mean time between symptom onset and arrival in the cath lab was 130 minutes; the mean door-to-groin time was 51 minutes; the mean time between alerting the cath lab and its operational readiness was 12 minutes. In 35 patients (56%) systemic fibrinolytic therapy was started after baseline imaging. In all cases access to the supra-aortic vessels was achieved. Mean time between puncture and angiography of the target vessel was 6.9 minutes. Stent implantation for extracranial stenosis or dissection was done in 12 cases (19%). Thrombectomy of intracranial occlusions was done with a stent retriever (n=51; 82%), a continuous aspiration device (n=10; 16%), a clot retriever (n=1; 1.6%), or using balloon angioplasty and local fibrinolytic therapy (n=3; 4.8%). In 15 cases (24%) a combination of different techniques was used. Mean time between arterial puncture and crossing the lesion was 28 minutes. Recanalization was technically successful (TICI flow 2b or 3) in 50 patients (81%). In one patient the stent retriever could not be retrieved as it was deployed in a prior implanted intracranial stent. Favorable clinical outcome at discharge (modified Rankin Scale of 0–2), was achieved in 58% of the patients. The 30-day mortality was 9% (n=6), 4 patients died as a direct consequence of the stroke (2 intracranial hemorrhages, 2 cerebral edema).

CONCLUSION Acute stroke interventions can be performed safely and with high technical success by interventional cardiologists.