Patients who received endovascular treatment for stroke by an interventional cardiologist and non-invasive stroke specialist team had non-inferior outcomes compared with those who received intervention performed by other endovascular specialists. These findings were published in JACC: Cardiovascular Interventions.
This prospective, single-center study was conducted at the Medical University of Silesia Katowice in Poland between 2019 and 2020. Patients (N=248) with imaging-confirmed large vessel occlusion acute ischemic stroke underwent endovascular treatment performed by multidisciplinary teams of interventional cardiologists, vascular surgeons, and neuroradiologists. Three-month outcomes were assessed on the basis of intervention team.
Patients were aged mean 68±13 years, 48% were women, 93% had anterior circulation stroke, 78% had hypertension, 31% coronary heart disease, and 24% diabetes. Overall, the median time from onset to revascularization was 255 minutes (IQR, 200-300), 59.4% received thrombolysis prior to mechanical thrombectomy, the procedure lasted a median of 110 minutes (IQR, 75-135), 73% had middle cerebral artery occlusion, and 21.4% had intracranial bleeding.
A total of 80 patients had an interventional cardiologist performing their procedure. Fewer patients who received care by the cardiologist team had thrombolysis in cerebral infarction (TICI) angiography scale 2b/3 (55.7% vs 71.7%; P =.013) and their procedures were significantly longer (median, 120 vs 105 min; P =.020).
Three-month mortality occurred among 31.3% of the cardiologist and 28.0% of the non-cardiologist cohorts (P =.595). Patients who did not survive had poorer renal function (P =.002), higher National Institutes of Health Stroke Scale (NIHSS) score at discharge (P =.002), and fewer had a satisfactory TICI result (P =.04).
In the univariate model, predictors of mortality were modified Rankin Scale (mRS) at discharge (odds ratio [OR], 4.0860; 95% CI, 1.6884-9.8884 per 1 point; P =.0018), chronic kidney disease (OR, 2.8190; 95% CI, 1.4122-5.6273; P =.0033), change in NIHSS score (OR, 1.1138; 95% CI, 1.0346-1.1992; P =.0024), NIHSS score 24-hours post intervention (OR, 1.0908; 95% CI, 1.0326-1.1523 per 1 point; P =.0014), and TICI 2b/3 status (OR, 0.5529; 95% CI, 0.3128-0.9772; P =.0414).
In the logistic regression analysis, only mRS at discharge remained significant (OR, 3.5015; 95% CI, 1.4581-8.4087 per 1 point; P =.0051).
This study may have been limited because the angiographic effect and reperfusion assessments were not performed by independent teams.
”Clinical endpoints including mortality and functional independence after 3 months are similar regardless of the interventionist performing the procedure,” the investigators noted. “The differences in the angiographic effects and the duration of procedures performed by cardiologists compared to other specialists require further observation and close monitoring.”
Wita K, Kułach A, Wilkosz K, et al. Mechanical thrombectomy in acute ischemic stroke – The role of interventional cardiologists – A prospective single center study. JACC Cardiovasc Interv. Published online February 9, 2022. doi:10.1016/j.jcin.2021.11.041