TY - JOUR
T1 - Thrombectomy in special populations
T2 - report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee
AU - On behalf of the SNIS Standards and Guidelines Committee and SNIS Board of Directors
AU - Al-Mufti, Fawaz
AU - Schirmer, Clemens M.
AU - Starke, Robert M.
AU - Chaudhary, Neeraj
AU - De Leacy, Reade
AU - Tjoumakaris, Stavropoula I.
AU - Haranhalli, Neil
AU - Abecassis, Isaac Josh
AU - Amuluru, Krishna
AU - Bulsara, Ketan R.
AU - Hetts, Steven W.
N1 - Publisher Copyright:
©
PY - 2021/7/8
Y1 - 2021/7/8
N2 - Background The purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis. Methods We performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence. Results MT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.
AB - Background The purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis. Methods We performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence. Results MT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.
KW - stroke
KW - thrombectomy
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U2 - 10.1136/neurintsurg-2021-017888
DO - 10.1136/neurintsurg-2021-017888
M3 - Article
C2 - 34244337
AN - SCOPUS:85109778718
SN - 1759-8478
VL - 14
SP - 1033
EP - 1041
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 10
ER -