First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
JACC Cardiovasc Interv. 2022 Mar 14;15(5):550-558. doi: 10.1016/j.jcin.2021.11.041. Epub 2022 Feb 9.
The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality.
MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy.
In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52).
Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar.
Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure.
本研究旨在评估由介入心脏病专家（IC）在卒中中心进行的机械取栓（MT）的安全性和结果，并与其他介入医师进行比较。主要终点为卒中幸存者 3 个月时的功能独立性（改良 Rankin 量表评分 0-2）。次要终点包括再通率、卒中严重程度降低和 3 个月死亡率。
MT 是治疗大血管闭塞性急性缺血性卒中的有效方法。将具有其基础设施的 IC 纳入综合卒中团队中可能会增加这种治疗方法的可及性。
在这项单中心前瞻性研究中，我们纳入了 248 例经证实存在大血管闭塞的缺血性卒中患者（平均年龄 68±13 岁，48%为女性）。这些操作由 IC（n=80）、血管外科医生（n=116）和神经放射科医生（n=52）进行。
由心脏病专家和其他专家进行操作的患者在 3 个月后的功能独立性相似（改良 Rankin 量表评分 0-2 的比例分别为 44%和 55%；P=0.275）。同样，3 个月时的死亡率也没有差异（28%和 31%；P=0.585）。心脏病专家进行的操作时间长于其他专家（120 分钟比 105 分钟；P=0.020）。由心脏病专家进行的操作中，血管造影成功（血栓切除术治疗脑梗死分级 2b 或 3）的比例较低（55.7%比 71.7%；P=0.013），但卒中严重程度的变化（24 小时后 NIHSS 评分）相似。
由介入心脏病专家与非侵入性卒中专家合作进行的卒中血管内治疗与其他血管内专家进行的操作相比并不劣效。无论介入医师进行操作，3 个月后的死亡率和功能独立性都相似。
