Clinical Research in Stroke

Kohli G.a· George D.D.a· Grenga A.a· Santangelo G.a· Gosev I.b· Schartz D.c· Kessler A.c· Khan I.a· Barrus B.d· Gu Y.e· Bhalla T.a· Mattingly T.K.a· Bender M.T.a

Author affiliations

aDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
bDivision of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
cDepartment of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
dBaptist Health Cardiothoracic Surgery Clinic, Little Rock, AR, USA
eDepartment of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA

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Article / Publication Details

First-Page Preview

Received: July 03, 2022
Accepted: October 20, 2022
Published online: January 30, 2023

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Introduction: The use of short-term mechanical circulatory support (MCS) devices and procedures for function- and life-sustaining therapy is becoming a routine practice at many centers. Concomitant with the increasing use of MCS is the increasing recognition of acute brain injuries, including acute ischemic stroke, which may be caused by a myriad of MCS-driven factors. The aim of this case series was to document our experience with mechanical thrombectomy (MT) for ischemic stroke in extracorporeal membrane oxygenation (ECMO) patients. Methods: We retrospectively reviewed a prospectively maintained database of patients undergoing endovascular thrombectomy for large vessel occlusion at our institution. We identified patients that were on ECMO and underwent thrombectomy. Baseline demographics and procedural and functional outcomes were collected. Results: Three patients on ECMO were identified to have a large vessel occlusion and underwent thrombectomy. Two patients had an internal carotid artery terminus occlusion and one had a basilar artery occlusion. An mTICI 3 recanalization was achieved in all patients without postoperative hemorrhagic complications. Two patients achieved a 3-month mRS of 1, while one had mRS 4. Conclusion: Ischemic stroke can be associated with significant morbidity in MCS patients. We demonstrate that MT can be safely performed in this patient population with good outcomes.

© 2023 S. Karger AG, Basel

References Combes A, Price S, Slutsky AS, Brodie D. Temporary circulatory support for cardiogenic shock. The Lancet. 2020 Jul 18;396(10245):199–212. Cho S-M, Canner J, Chiarini G, Calligy K, Caturegli G, Rycus P, et al. Modifiable risk factors and mortality from ischemic and hemorrhagic strokes in patients receiving venoarterial extracorporeal membrane oxygenation: results from the Extracorporeal Life Support Organization registry. Crit Care Med. 2020 Oct;48(10):e897–905. Sutter R, Tisljar K, Marsch S. Acute neurologic complications during extracorporeal membrane oxygenation: a systematic review. Crit Care Med. 2018 Sep;46(9):1506–13. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018 Feb 22;378(8):708–18. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018 Jan 4;378(1):11–21. Sun LR, Pearl M, Bahouth MN, Carrasco M, Hoops K, Schuette J, et al. Mechanical thrombectomy in an infant with acute embolic stroke. Pediatr Neurol. 2018 May;82:53–4. Le Guennec L, Schmidt M, Clarençon F, Elhfnawy AM, Baronnet F, Kalamarides M, et al. Mechanical thrombectomy in acute ischemic stroke patients under venoarterial extracorporeal membrane oxygenation. J Neurointerv Surg. 2020 May;12(5):486–8. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP, et al. The PROCESS 2018 statement: updating consensus preferred reporting of CasE series in Surgery (PROCESS) guidelines. Int J Surg. 2018 Dec;60:279–82. McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, et al. Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002–2012. Semin Thorac Cardiovasc Surg. 2015 Jul 22;27(2):81–8. Barbaro RP, MacLaren G, Boonstra PS, Combes A, Agerstrand C, Annich G, et al. Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international extracorporeal life support organization registry. Lancet. 2021 Oct 2;398(10307):1230–8. Alraies MC, Eckman P. Adult heart transplant: indications and outcomes. J Thorac Dis. 2014 Aug;6(8):1120–8. Cho S-M, Canner J, Caturegli G, Choi CW, Etchill E, Giuliano K, et al. Risk factors of ischemic and hemorrhagic strokes during venovenous extracorporeal membrane oxygenation: analysis of data from the Extracorporeal Life Support Organization registry. Crit Care Med. 2021 Jan 1;49(1):91–101. Illum B, Odish M, Minokadeh A, Yi C, Owens RL, Pollema T, et al. Evaluation, treatment, and impact of neurologic injury in adult patients on extracorporeal membrane oxygenation: a review. Curr Treat Options Neurol. 2021 Mar 31;23(5):15. Prodhan P, Fiser RT, Cenac S, Bhutta AT, Fontenot E, Moss M, et al. Intrahospital transport of children on extracorporeal membrane oxygenation: indications, process, interventions, and effectiveness. Pediatr Crit Care Med. 2010 Mar;11(2):227–33. Viamonte MA, Yu J, Echevarria FD, Nagae L, Youn TS, Tahsili-Fahadan P, et al. Caveats to acute imaging for acute stroke in the setting of venoarterial extracorporeal membrane oxygenation. Neurol Clin Pract. 2021 Dec;11(6):e959–61. Brenna CTA, Ku JC, Pasarikovski CR, Priola SM, Dyer EE, Howard P, et al. Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study. Neurosurg Focus. 2021 Jul;51(1):E3. Baran DA. Extracorporeal membrane oxygenation (ECMO) and the critical cardiac patient. Curr Transplant Rep. 2017 Jul 10;4(3):218–25. Schartz D, Akkipeddi SMK, Ellens N, Rahmani R, Kohli GS, Bruckel J, et al. Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis. J Neurointerv Surg. 2022;14(8):820–5. neurintsurg-2021-018032 Siddiqui AH, Waqas M, Neumaier J, Zhang JF, Dossani RH, Cappuzzo JM, et al. Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention. J Neurointerv Surg. 2021 Aug;13(8):687–92. Svrckova P, Meshaka R, Holtrup M, Aramburo A, Mankad K, Kazmi F, et al. Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease: ultrasound with multimodality correlation. Pediatr Radiol. 2020 Jun;50(7):997–1009. Wood KL, Ayers B, Gosev I, Kumar N, Melvin AL, Barrus B, et al. Venoarterial-extracorporeal membrane oxygenation without routine systemic anticoagulation decreases adverse events. Ann Thorac Surg. 2020 May;109(5):1458–66. Article / Publication Details

First-Page Preview

Received: July 03, 2022
Accepted: October 20, 2022
Published online: January 30, 2023

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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