Brief Report Mechanical Thrombectomy in Perioperative Strokes A Case–Control Study Kévin Premat, MD; Olivier Clovet, MD; Giulia Frasca Polara, MD; Eimad Shotar, MD; Bruno Bartolini, MD; Marion Yger, MD; Federico Di Maria, MD; Flore Baronnet, MD, PhD; Silvia Pistocchi, MD; Raphaël Le Bouc, MD, PhD; Christine Pires, MSc; Nader Sourour, MD; Sonia Alamowitch, MD, PhD; Yves Samson, MD; Vincent Degos, MD, PhD*; Frédéric Clarençon, MD, PhD*

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Background and Purpose—Perioperative strokes (POS) are rare but serious complications for which mechanical thrombectomy could be beneficial. We aimed to compare the technical results and patients outcomes in a population of POS versus non-POS (nPOS) treated by mechanical thrombectomy. Methods—From 2010 to 2017, 25 patients with POS (ie, acute ischemic stroke occurring during or within 30 days after a procedure) who underwent mechanical thrombectomy (POS group) were enrolled and paired with 50 consecutive patients with nPOS (control group), based on the occlusion’s site, National Institute of Health Stroke Scale, and age. Results—Respectively, mean age was 68.3±16.6 versus 67.2±16.6 years (P=0.70), and median National Institute of Health Stroke Scale score at admission was 20 (interquartile range, 15–25) versus 19 (interquartile range, 17–25; P=0.79). Good clinical outcome (modified Rankin Scale score of 0–2 at 3 months) was achieved by 33.3% (POS) versus 56.5% (nPOS) of patients (P=0.055). Successful reperfusion (modified Thrombolysis In Cerebral Infarction score of ≥2b) was obtained in 76% (POS) versus 86% (nPOS) of cases (P=0.22). Mortality at 3 months was 33.3% in the POS group versus 4.2% (nPOS) (P=0.002). The rate of major procedural complications was 4% (POS) versus 6% (nPOS); none were lethal. Average time from symptoms’ onset to reperfusion was 4.9 hours (±2.0) in POS versus 5.2 hours (±2.6). Conclusions—Successful reperfusion seems accessible in POS within a reasonable amount of time and with a good level of safety. However, favorable outcome was achieved with a lower rate than in nPOS, owing to a higher mortality rate.   (Stroke. 2017;48:00-00. DOI: 10.1161/STROKEAHA.117.018033.) Key Words: basilar artery ◼ postoperative complications ◼ reperfusion ◼ stroke ◼ thrombectomy

P

comparison to a pair-matched control population who underwent MT for nPOS.

erioperative strokes (POS), defined as the occurrence of an acute ischemic stroke during or within 30 days after an intervention, remain rare complications, more frequently observed after neurological, cardiac, or vascular surgeries.1,2 Even with the best medical treatment, they are known to be associated with high mortality (≈25%3) and disability rates, especially in comparison to non-POS (nPOS).4–7 Recently, the management of acute ischemic stroke with large-vessel occlusion has been drastically modified, placing mechanical thrombectomy (MT) as the spearhead of the reperfusion strategy.8 Considering that intravenous thrombolysis is usually not a suitable option in a postoperative context, patients with POS caused by vascular occlusion are good candidates for MT. This study aimed to evaluate the technical results and the clinical outcome of patients with POS treated by MT in

Materials and Methods Neither approval of the institutional review board nor patients’ informed consent was required by the ethics committee of our institution for retrospective analyses of patients records and imaging data.

Study Design We retrospectively reviewed our prospectively filled database of MTs performed between 2008 and 2017 and included all consecutive patients treated for POS. The control group (nPOS group) was constituted of consecutive patients from the same database who underwent MT for nPOS. Each patient was matched (2:1) with patients from the POS group based on 3 parameters: occlusion site, National Institute of Health Stroke

Received May 26, 2017; final revision received August 18, 2017; accepted September 14, 2017. From the Department of Interventional Neuroradiology (K.P., E.S., B.B., F.D.M., S.P., N.S., F.C.), Department of Neuro-Intensive Care (O.C., V.D.), and Department of Vascular Neurology (G.F.P., F.B., R.L., C.P., Y.S.), Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, UPMC University Paris-06, France (E.S., F.B., R.L., S.A., V.D., F.C.); and Department of Vascular Neurology, Saint-Antoine Hospital, Paris, France (M.Y., S.A.). *Drs Degos and Clarençon contributed equally. The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA. 117.018033/-/DC1. Correspondence to Frédéric Clarençon, MD, PhD, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, 75013 Paris, France. E-mail [email protected] © 2017 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org

DOI: 10.1161/STROKEAHA.117.018033

1

2  Stroke  November 2017 Table 1.  Demographics and Preprocedural Details

evaluation criteria included the rate of successful reperfusion (modified Thrombolysis in Cerebral Infarction9 score of 2b or 3) and the rate of major procedure-related complications.

Parameter

POS Group; n=25

nPOS Group; n=50

P Value*

Age (±SD)

68.3 (±16.6)

67.2 (±16.6)

0.70

Statistical Analysis

14 (56)

27 (54)

0.37

Data analysis was performed using Epi Info™ 7.1.5.2 (Centers for Disease Control and Prevention, Atlanta, GA). Fisher exact test was used to compare frequencies, and comparison of means was performed using a Student t test or Wilcoxon test, depending on the data distribution. Results were considered statistically significant when P value