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Mechanical Thrombectomy in Perioperative Strokes: A Case-Control Study.

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Summary

Mechanical thrombectomy for perioperative strokes (POS) shows promising reperfusion rates and safety. However, POS patients experienced lower favorable outcomes and significantly higher mortality compared to non-POS patients.

Keywords:
basilar arterypostoperative complicationsreperfusionstrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Perioperative strokes (POS) are rare but severe complications.
  • Mechanical thrombectomy is a potential treatment for acute ischemic stroke.

Purpose of the Study:

  • To compare technical results and patient outcomes of mechanical thrombectomy in POS versus non-POS patients.
  • To evaluate the efficacy and safety of mechanical thrombectomy for perioperative strokes.

Main Methods:

  • A retrospective study comparing 25 POS patients with 50 matched non-POS (nPOS) patients undergoing mechanical thrombectomy from 2010 to 2017.
  • Matching criteria included occlusion site, NIH Stroke Scale, and age.
  • Outcomes assessed included clinical outcome (modified Rankin Scale), reperfusion (mTICI score), mortality, and procedural complications.

Main Results:

  • No significant difference in age or baseline NIH Stroke Scale between groups.
  • Successful reperfusion (mTICI ≥2b) rates were 76% in POS vs. 86% in nPOS (P=0.22).
  • Good clinical outcome (mRS 0-2) was achieved by 33.3% of POS vs. 56.5% of nPOS (P=0.055).
  • Mortality at 3 months was significantly higher in the POS group (33.3%) vs. nPOS (4.2%) (P=0.002).
  • Procedural complication rates were similar and low (4% POS vs. 6% nPOS).

Conclusions:

  • Mechanical thrombectomy is technically feasible and safe for perioperative strokes.
  • While reperfusion is achievable, favorable outcomes are less frequent in POS patients compared to nPOS.
  • Higher mortality rates in POS patients necessitate further investigation and management strategies.