Should Interventional Cardiologists Be Involved in Acute Stroke?

According to this single-site study, published in J Am Coll Cardiol Intv., interventional cardiologists can safely conduct revascularizations in a setting of acute stroke, with high clinical and technical success. Cardiologists are taking on this traditional interventional neurology field simply due to the lack of interventional neurologists, who are thus unable to provide coverage 24/7, 365 days per year.

However, this brings about hidden costs. Even cardiologists with great experience and technical skills have limited knowledge of intracranial anatomy, CTs, MRIs, clinical aspects, and—particularly—how to manage catastrophic complications such as intracranial bleeding.

There should be no shortcuts in training. Thinking that a given vascular disease is similar to all others is a big mistake.

Taking into account that acute stroke interventions have not improved mortality, only disability (a much softer endpoint), and that a complication such as intracranial bleeding can reach a mortality rate of up to 70%, it is easy to imagine that a slight increase in the rate of complications can translate into a prognosis that is worse than natural disease progression.

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The study included 70 consecutive patients who, between 2012 and 2018, underwent acute stroke intervention for large-vessel occlusion. In 61% of cases, patients received fibrinolytic therapy after baseline imaging.

The mean time between symptom onset and arrival to the cath lab was 138 minutes, and the mean door-to-vascular access time was 64 minutes.

The best aspect of this work (one that a team of interventional neurologists would have a hard time reproducing) are the mere 13 minutes required between interventional team activation and its readiness. Undoubtedly, our experience and organization in relation to acute myocardial infarction has paid up.

In most patients, thrombectomy was done with a stent retriever. An aspiration system or a combination of techniques were also used.

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Recanalization was technically successful (Thrombolysis In Cerebral Infarction flow grade 2b or 3) in 93% of patients.

The 30-day mortality was 18% and favorable clinical outcome (modified Rankin scale score of 0 to 2) was achieved in 61% at 3 months.

Conclusion

Acute stroke interventions can be conducted safely and with high technical and clinical success by experienced interventional cardiologists.

Original title: Acute Stroke Interventions Performed by Cardiologists Initial Experience in a Single Center.

Reference: Marius Hornung et al. J Am Coll Cardiol Intv 2019;12:1703–10.

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