Effect of Left Ventricular Systolic Dysfunction on the Outcome of Mechanical Thrombectomy
Satoshi Miyamoto1,2, Yoshiro Ito1,2, Shinichiro Numao2
1Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Insights
Left ventricular systolic dysfunction did not worsen stroke outcomes after mechanical thrombectomy. This condition may improve cerebral collateral flow, offering a compensatory mechanism during ischemic stroke.
Area of Science:
- Neurology
- Cardiology
- Stroke Medicine
Background:
- Left ventricular systolic dysfunction is typically a poor prognostic indicator for stroke.
- However, it may paradoxically improve cerebral collateral circulation, acting as a compensatory mechanism in ischemic stroke.
Purpose of the Study:
- To investigate the impact of left ventricular systolic dysfunction on outcomes following mechanical thrombectomy (MT).
- To explore the relationship between left ventricular systolic dysfunction and cerebral collateral flow in ischemic stroke patients undergoing MT.
Main Methods:
- Retrospective cohort study of 94 acute ischemic stroke patients who underwent MT.
- Patients were stratified into reduced ejection fraction (EF ≤40%) and preserved EF (>40%) groups.
- Evaluated post-treatment stroke volume, clinical outcomes, hospital stay, and cerebral collateral flow.
Main Results:
- No significant differences in stroke volume, hospital stay, or favorable outcomes between reduced and preserved EF groups.
- Patients with reduced EF showed significantly better development of cerebral collateral flow (56% vs. 13%, p=0.008).
- Adjusted analysis indicated no significant difference in favorable outcomes for the reduced EF group (OR 0.693, p=0.600).
Conclusions:
- Left ventricular systolic dysfunction does not appear to significantly worsen outcomes after mechanical thrombectomy.
- Chronic hypoperfusion associated with reduced EF may promote collateral circulation, potentially improving stroke resistance.
Objective:
Left ventricular systolic dysfunction has traditionally been considered an unfavorable prognostic factor in stroke. However, chronic hypoperfusion due to this dysfunction may improve cerebral collateral flow, potentially serving as a compensatory mechanism during ischemic stroke. This study aimed to investigate the effects of left ventricular systolic dysfunction on outcomes after mechanical thrombectomy (MT), with a focus on cerebral collateral flow.
Methods:
This retrospective cohort study included 94 consecutive patients with acute ischemic stroke who underwent MT between April 2017 and July 2022. Patients were divided into 2 groups based on their left ventricular ejection fraction (EF): the reduced EF group (EF ≤40%) and the preserved EF group (EF >40%). We evaluated post-treatment stroke volume, clinical outcomes, length of hospital stay, and the relationship between EF and cerebral collateral flow.
Results:
The reduced and preserved EF groups consisted of 11 (12%) and 83 (88%) patients, respectively. No significant differences were observed in post-treatment stroke volume (13 vs. 12 cm3, p = 0.779), hospital stay duration (23 vs. 22 days, p = 0.634), or favorable clinical outcomes at discharge (36% vs. 43%, p = 0.754) between the 2 groups. The odds ratio for favorable outcomes at discharge, adjusted using inverse probability of treatment weighting, was 0.693 (95% confidence interval: 0.176-2.732, p = 0.600) for the reduced EF group compared with the preserved EF group. Cerebral collateral flow developed better in the reduced EF group (56% vs. 13%, p = 0.008).
Conclusion:
Left ventricular systolic dysfunction did not significantly worsen outcomes after MT. Chronic cerebral hypoperfusion due to left ventricular systolic dysfunction may promote the development of cerebral collaterals, potentially enhancing resistance to ischemic events.
More Related Videos
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
