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Updated: Dec 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory
Steven A Guidera1, Sudhir Aggarwal2, J Doyle Walton1
1Division of Cardiology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania.
Insights
Establishing a mechanical thrombectomy program using interventional cardiologists is feasible for acute ischemic stroke care. This approach can improve patient outcomes by increasing access to timely reperfusion therapy.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Mechanical thrombectomy (MT) is recommended for acute ischemic stroke with large vessel occlusion.
- Treatment delays due to lack of neurointerventionalists reduce MT efficacy.
- Community hospitals often lack specialized neurointerventional teams.
Purpose of the Study:
- To assess the feasibility of implementing a mechanical thrombectomy program in a community hospital.
- To evaluate the use of interventional cardiologists for MT in acute ischemic stroke.
- To determine if collaboration between interventional cardiologists and neurologists can improve stroke care.
Main Methods:
- An MT program was established within a cardiac catheterization laboratory.
- Interventional cardiologists, supported by ST-elevation myocardial infarction teams, performed MT procedures.
- Neurologists collaborated closely with interventional cardiologists throughout the process.
Main Results:
- Forty patients underwent attempted MT for acute ischemic stroke.
- Successful reperfusion (TICI grade 2b or 3) was achieved in 80% of patients.
- At 90 days, 55% of patients achieved functional independence (modified Rankin score ≤2).
- In-hospital mortality was 13%, with symptomatic intracranial hemorrhage in 15% and major vascular complications in 5%.
Conclusions:
- Interventional cardiologists with carotid stenting experience can successfully perform MT for acute ischemic stroke.
- This model enhances access to timely stroke treatment in hospitals without neurointerventionists.
- Collaborative efforts between cardiology and neurology can optimize acute stroke care delivery.
Objectives:
The aim of this study was to determine the feasibility of establishing a mechanical thrombectomy (MT) program for acute ischemic stroke in a community hospital using interventional cardiologists working closely with neurologists.
Background:
American Heart Association/American Stroke Association 2018 guidelines give a Class I (Level of Evidence: A) recommendation for MT in eligible patients with large vessel occlusion stroke. Improvement in neurological outcomes with MT is highly time sensitive. Most hospitals do not have trained neurointerventionalists to perform MT, leading to treatment delays that reduce the benefit of reperfusion therapy.
Methods:
An MT program based in the cardiac catheterization laboratory was developed using interventional cardiologists with ST-segment elevation myocardial infarction teams.
Results:
Forty patients underwent attempted MT for acute ischemic stroke. An additional 5 patients who underwent angiography did not undergo attempted thrombectomy, because of absence of target thrombus (n = 4) or unsuitable anatomy (n = 1). Median National Institutes of Health Stroke Scale score prior to MT was 19 and at discharge was 7. TICI (Thrombolysis In Cerebral Infarction) grade 2b or 3 flow was restored in 80% of patients (32 of 40). At 90 days, 55% of patients (22 of 40) were functionally independent (modified Rankin score ≤2). In-hospital mortality was 13% (5 of 40). Symptomatic intracranial hemorrhage occurred in 15% of patients (6 of 40). Major vascular complications occurred in 5% of patients (2 of 40).
Conclusions:
MT can be successfully performed by interventional cardiologists with carotid stenting experience working closely with neurologists in hospitals lacking formally trained neurointerventionists. This model has the potential to increase access to timely care for patients with acute ischemic stroke.
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