Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra-arterial nimodipine might be associated with worse outcomes.
mechanical thrombectomy
nimodipine
vasospasm
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
09 Sep 2024
09 Sep 2024
Historique:
revised:
06
08
2024
received:
26
06
2024
accepted:
20
08
2024
medline:
9
9
2024
pubmed:
9
9
2024
entrez:
9
9
2024
Statut:
aheadofprint
Résumé
Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra-arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra-arterial nimodipine on outcomes after MT for large vessel occlusion stroke. We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0-1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical). Among 13,678 patients in the registry during the study period, 434 received intra-arterial nimodipine for the treatment of MT-related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63-0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42-0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45-0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54-3.08). Arterial vasospasm occurring during the MT procedure and requiring intra-arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Vasospasm is a common iatrogenic event during mechanical thrombectomy (MT). In such circumstances, intra-arterial nimodipine administration is occasionally considered. However, its use in the treatment of iatrogenic vasospasm during MT has been poorly studied. We investigated the impact of iatrogenic vasospasm treated with intra-arterial nimodipine on outcomes after MT for large vessel occlusion stroke.
METHODS
METHODS
We conducted a retrospective analysis of the multicenter observational registry Endovascular Treatment in Ischemic Stroke (ETIS). Consecutive patients treated with MT between January 2015 and December 2022 were included. Patients treated with medical treatment alone, without MT, were excluded. We also excluded patients who received another in situ vasodilator molecule during the procedure. Outcomes were compared according to the occurrence of cervical and/or intracranial arterial vasospasm requiring intraoperative use of in situ nimodipine based on operator's decision, using a propensity score approach. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcomes included excellent outcome (mRS score 0-1), final recanalization, mortality, intracranial hemorrhage and procedural complications. Secondary analyses were performed according to the vasospasm location (intracranial or cervical).
RESULTS
RESULTS
Among 13,678 patients in the registry during the study period, 434 received intra-arterial nimodipine for the treatment of MT-related vasospasm. In the main analysis, comparable odds of favorable outcome were observed, whereas excellent outcome was significantly less frequent in the group with vasospasm requiring nimodipine (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.63-0.97). Perfect recanalization, defined as a final modified Thrombolysis In Cerebral Infarction score of 3 (aOR 0.63, 95% CI 0.42-0.93), was also rarer in the vasospasm group. Intracranial vasospasm treated with nimodipine was significantly associated with worse clinical outcome (aOR 0.64, 95% CI 0.45-0.92), in contrast to the cervical location (aOR 1.37, 95% CI 0.54-3.08).
CONCLUSION
CONCLUSIONS
Arterial vasospasm occurring during the MT procedure and requiring intra-arterial nimodipine administration was associated with worse outcomes, especially in case of intracranial vasospasm. Although this study cannot formally differentiate whether the negative consequences were due to the vasospasm itself, or nimodipine administration or both, there might be an important signal toward a substantial clinical impact of iatrogenic vasospasm during MT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16467Informations de copyright
© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Goyal M, Menon BK, Van Zwam WH, et al. Endovascular thrombectomy after large‐vessel ischaemic stroke: a meta‐analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723‐1731.
Turc G, Bhogal P, Fischer U, et al. European stroke organisation (ESO) ‐ European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical Thrombectomy in acute Ischaemic StrokeEndorsed by stroke Alliance for Europe (SAFE). Eur Stroke J. 2019;4:6‐12.
Connolly ESJ, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43:1711‐1737.
Boulouis G, Labeyrie MA, Raymond J, et al. Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta‐analysis. Eur Radiol. 2017;27:3333‐3342.
Yao Z, Hu X, You C. Endovascular therapy for vasospasm secondary to subarachnoid hemorrhage: a meta‐analysis and systematic review. Clin Neurol Neurosurg. 2017;163:9‐14.
Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15:1138‐1147. https://www.sciencedirect.com/science/article/pii/S1474442216301776
Saver JL, Goyal M, Bonafe A, et al. Stent‐retriever Thrombectomy after intravenous t‐PA vs. t‐PA alone in stroke. N Engl J Med. 2015;372:2285‐2295.
Jovin T, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. NEJM. 2015;372:2296‐2306.
Jesser J, Awounvo S, Vey JA, et al. Prediction and outcomes of cerebral vasospasm in ischemic stroke patients receiving anterior circulation endovascular stroke treatment. Eur Stroke J. 2023;8:684‐691.
Akins PT, Amar AP, Pakbaz RS, Fields JD. Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and merci devices. Am J Neuroradiol. 2014;35:524‐528. https://www.ajnr.org/content/35/3/524
Jesser J, Nguyen T, Dmytriw AA, et al. Treatment Practice of Vasospasm during Endovascular Thrombectomy: an International Survey. Stroke Vasc; 2023.
Behme D, Gondecki L, Fiethen S, Kowoll A, Mpotsaris A, Weber W. Complications of mechanical thrombectomy for acute ischemic stroke‐a retrospective single‐center study of 176 consecutive cases. Neuroradiology. 2014;56:467‐476.
Happi Ngankou E, Gory B, Marnat G, et al. Thrombectomy complications in large vessel occlusions: incidence, predictors, and clinical impact in the ETIS registry. Stroke. 2021;52:e764‐e768.
Jesser J, Potreck A, Vollherbst D, et al. Effect of intra‐arterial nimodipine on iatrogenic vasospasms during endovascular stroke treatment—angiographic resolution and infarct growth in follow‐up imaging. BMC Neurol. 2023;23:5.
Uchikawa H, Kuroiwa T, Nishio A, et al. Vasospasm as a major complication after acute mechanical thrombectomy with stent retrievers. J Clin Neurosci off J Neurosurg Soc Australas. 2019;64:163‐168.
Gory B, Finitsis S, Olivot J‐M, et al. Intravenous thrombolysis before complete angiographic reperfusion: beyond angiographic assessment to target microvascular obstruction? Ann Neurol. 2023;95:762‐773.
Zhu F, Gauberti M, Marnat G, et al. Time from I.V. Thrombolysis to Thrombectomy and outcome in acute ischemic stroke. Ann Neurol. 2021;89:511‐519.
Berge E, Whiteley W, Audebert H, et al. European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6:I‐LXII.
Turc G, Bhogal P, Fischer U, et al. European stroke organisation (ESO) ‐ European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical Thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11:535‐538.
Thomas LE, Li F, Pencina MJ. Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial. JAMA. 2020;323:2417‐2418.
Pagiola Igor Amaral Bruno SCNDCJHFM. How to differentiate intracranial atherosclerotic disease or vasospasms after mechanical thrombectomy. Be patient or vasodilator is the secret? J Cerebrovasc Endovasc Neurosurg. 2021;23:60‐63. http://the‐jcen.org/journal/view.php?number=750
Puntonet J, Richard M‐E, Edjlali M, et al. Imaging findings after mechanical Thrombectomy in acute ischemic stroke. Stroke. 2019;50:1618‐1625. doi:10.1161/STROKEAHA.118.024754
Abdalla RN, Cantrell DR, Shaibani A, et al. Refractory stroke Thrombectomy: prevalence, etiology, and adjunctive treatment in a north American cohort. AJNR Am J Neuroradiol. 2021;42:1258‐1263.
Schirmer CM, Hoit DA, Malek AM. Iatrogenic vasospasm in carotid artery stent angioplasty with distal protection devices. Neurosurg Focus. 2008;24:E12.
Sriganesh K, Venkataramaiah S, Palaniswamy SR, Ramalingaiah AH. Effect of intra‐arterial Nimodipine on cerebral oxygen saturation and systemic hemodynamic indices in patients with cerebral vasospasm: a prospective cohort study. J Neurosurg Anesthesiol. 2020;32:177‐181.
Bernava G, Tesoro R, Boto J, et al. Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci. 2023;15910199231221510. Epub ahead of print. doi:10.1177/15910199231221510
Hori S, Furudate R, Kumagai I, Aoyagi C, Hirota N, Yamamoto T. Use of a stent‐retriever for treatment of iatrogenic vasospasm secondary to mechanical thrombectomy. Clin Neurol Neurosurg. 2023;236:108107.
Flottmann F, Brekenfeld C, Broocks G, et al. Good clinical outcome decreases with number of retrieval attempts in stroke Thrombectomy: beyond the first‐pass effect. Stroke. 2021;52:482‐490.