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Endovascular treatment in large vessel occlusion stroke patients treated with OAC

Presented by
Mr Clemens K√ľpper, Ludwig-Maximilians-University of Munich, Germany
EAN 2020
German Stroke Registry-Endovascular Treatment
Endovascular treatment appears to be safe and efficacious in patients with large vessel occlusion stroke in patients using oral anticoagulation (OAC). This was suggested by the outcomes of a large-scale retrospective study analysing data from the German Stroke Registry-Endovascular Treatment [1].

Primary outcomes were successful recanalisation, defined as modified thrombolysis in cerebral infarction (mTICI 2b-3), good outcome at 3 months according to modified Rankin scale (mRS; 0-2 or back to baseline), and rates of intracranial haemorrhage (ICH) until hospital discharge.

The analysis included 2,521 stroke patients, of whom 442 (17.6%) were treated with OACs, 201 (8.0%) with vitamin-K antagonists (VKA), and 241 (9.6%) with non-vitamin-K antagonist oral anticoagulants (NOACs). OAC users were older, had more often a history of atrial fibrillation, and had a higher rate of arterial hypertension (see Table).

The rate of mTICI 2b-3 was similar among all 3 groups (82.7%, 85.5%, and 82.7%; P=1.00 and P=0.57). The other main results after 90 days:

  • A favourable outcome was less frequent in OAC patients (28.4%, 31.1%, and 40.9%; P<0.005 and P<0.05);
  • ICH rates were similar among the 3 groups (12.1%, 12.4%, and 10.4%; P=1.00 and P=0.86);
  • OAC status had no influence on good outcome (OR 1.03; 95% CI 0.99-1.08);
  • OAC status did not affect ICH risk (OR 1.03; 95% CI 0.94-1.05).
Table. Baseline patient, stroke, imaging, and treatment characteristics [1]

OAC, oral anticoagulation; VKA, vitamin-K antagonist; NOAC, non-vitamin-K oral anticoagulant; pmRS, premorbid modified Rankin Scale; NIHSS, National Institute of Health Stroke Scale; mTICI, modified thrombolysis in cerebral infarction; ICH, intracranial haemorrhage

  1. K√ľpper C, et al. Abstract EPR2022, EAN 2020.


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