Endovascular Intervention for Post Cardiac Catheterization Ischemic Strokes (P05.265)

Abstract

Objective: To report an outcome of post cardiac catheterization stroke patients treated with endovascular intervention. Background Cardiac catheterization related stroke has an incidence of 0.03% to 0.3% for diagnostic procedures and 0.3–0.4% for percutaneous coronary intervention (PCI). Endovascular interventions have added a new option for treatment in patients with embolic occlusion of large vessel occlusion. Design/Methods: Following retrospective data was collected from 2007 to September 2011 for post cardiac catheterization stroke and endovascular intervention : demographics, risk factors, National Institute of Health Stroke Scale- NIHSS, arterial involvement, type of intervention, outcome. Results: Nine patients underwent cerebral angiogram for post cardiac catheterization stroke. Five patients (mean age- 76.3 years, 1 male and 4 female, all black) had large arterial occlusion, 2 middle cerebral, 1 carotid bifurcation, 1 anterior cerebral, 1 basilar artery. All patients had history of hypertension, hyperlipidemia and coronary atherosclerosis. Two had severe heart failure, one had left ventricular thrombus and one had descending aorta thrombus. None of them had atrial fibrillation. Median NIHSS was 17.5. All interventions were performed within 8 hours of symptoms. Three received intravenous thrombolysis. Pre TIMI score was 0 in 4 and 1 in 1 patient. Intra arterial thrombolysis was used in 3 while mechanical thrombectomy (MERCI or Penumbra) in 4. Post procedure, 3 patients had TIMI 3 recanalization and 2 had TIMI 2. None of them had hemorrhage. Two patients (Basilar, carotid bifurcation occlusion) died during hospitalization due to large stroke in spite of recanalization. At discharge, modified Rankin scale was 2 in 2 patients and 3 in 1. Conclusions: Some patients with post-cath large vessel occlusion can be salvaged with a reasonable functional outcome. Mortality/bad outcome rate remains high with endovascular intervention in spite of good recanalization rate. Further data is needed to evaluate the factors predicting the outcome in this group of patients. Disclosure: Dr. Kansara has nothing to disclose. Dr. Damani has nothing to disclose. Dr. Tiwari has nothing to disclose. Dr. Narayanan has nothing to disclose. Dr. Chaturvedi has received personal compensation for activities with Genentech, Inc., and Abbott Vascular. Dr. Xavier has received personal compensation for activities with Concentric as a consultant.