Jazayeri Seyed Behnam, Al-Janabi Omar M, Ghozy Sherief, Rabinstein Alejandro A, Kadirvel Ramanathan, Kallmes David F
Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Building 7, Hassan-Abad Square, 11365-3876, Tehran, Iran.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Cardiovasc Intervent Radiol. 2025 Jan;48(1):45-58. doi: 10.1007/s00270-024-03890-y. Epub 2024 Nov 27.
The purpose of this study is to pool the evidence on the safety and efficacy of mechanical thrombectomy (MT) in patients who develop acute ischemic stroke (AIS) due to large vessel occlusion (LVO) following recent cardiac interventions.
PubMed, Embase and Scopus were searched from inception up to February 2024 using a combination of "cardiac interventions" and "mechanical thrombectomy" as keywords. Studies that evaluated AIS within 30 days of a recent cardiac intervention who underwent MT were included. The proportion of mortality, favorable functional outcome (modified Rankin Scale (mRS) 0-2), successful reperfusion (TICI ≥ 2b or TIMI ≥ 2) and symptomatic intracranial hemorrhage (sICH) were pooled using generalized linear mixed model.
Thirty-one case reports/series and 11 observational studies including 195 MT procedures were included. The patients' mean age was 72 years. The most common cardiac intervention associated with AIS was transcatheter aortic valve replacement/implantation in 96/192 cases (50%). The median onset of stoke was 0 (IQR 0-3) days after cardiac intervention. Rate of successful reperfusion was 79.4% [95%confidence interval (CI) 66.7-88.1%], rate of mRS 0-2 after 90 days was 42.7% [95%CI 32.5-53.6%], and rate of mortality at 90 days was 30.3% [95%CI 21.7-40.6%]. The rate of sICH was 11.6% [95%CI 5.9-21.5%].
MT to treat AIS due to LVO after cardiac interventions may result in good rates of functional recovery, though mortality and sICH may be higher. Regular and repeated neurological examinations should be performed following cardiac interventions, with special attention to stroke. If stroke is detected, MT should be considered as a viable option.
本研究旨在汇总有关机械取栓术（MT）对近期心脏介入治疗后因大血管闭塞（LVO）而发生急性缺血性卒中（AIS）患者的安全性和有效性的证据。
以“心脏介入治疗”和“机械取栓术”为关键词，对PubMed、Embase和Scopus从创刊至2024年2月进行检索。纳入评估近期心脏介入治疗后30天内接受MT的AIS患者的研究。使用广义线性混合模型汇总死亡率、良好功能结局（改良Rankin量表[mRS] 0 - 2）、成功再灌注（脑梗死溶栓分级[TICI]≥2b或心肌梗死溶栓分级[TIMI]≥2）和症状性颅内出血（sICH）的比例。
纳入31篇病例报告/系列研究和11项观察性研究，共195例MT手术。患者平均年龄为72岁。与AIS相关的最常见心脏介入治疗是经导管主动脉瓣置换/植入术，96/192例（50%）。卒中的中位发病时间为心脏介入治疗后0（四分位间距0 - 3）天。成功再灌注率为79.4%[95%置信区间（CI）66.7 - 88.1%]，90天后mRS 0 - 2率为42.7%[95%CI 32.5 - 53.6%]，90天死亡率为30.3%[95%CI 21.7 - 40.6%]。sICH率为11.6%[95%CI 5.9 - 21.5%]。
心脏介入治疗后采用MT治疗因LVO导致的AIS可能会有较好的功能恢复率，尽管死亡率和sICH可能较高。心脏介入治疗后应定期进行反复的神经学检查，特别关注卒中情况。如果检测到卒中，应考虑将MT作为一种可行的选择。
