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Endovascular management of acute large vessel occlusion stroke in pregnancy is safe and feasible.

Abstract：

INTRODUCTION:Stroke is a leading cause of adult death and disability. Although acute ischemic stroke (AIS) in pregnancy is rare, it has devastating consequences on the life of the mother and fetus. Pregnancy was an exclusion criterion in endovascular thrombectomy (EVT) trials and so there are no evidence-based treatment recommendations in this subgroup. The objective of this study was to evaluate the safety and feasibility of mechanical thrombectomy in large vessel occlusion (LVO) stroke in pregnancy. METHODS:Patients with AIS due to LVO treated with EVT during pregnancy between 2000 and 2019 were identified at seven tertiary care centers. After IRB approval, retrospective analysis of prospectively maintained stroke/endovascular databases was performed. RESULTS:A total of seven subjects were identified. The average age was 33.2 years (range 25-38 years) and the average initial National Institutes of Health Stroke Scale (NIHSS) score at presentation was 15 (range 9-28). Three patients received IV tissue plasminogen activator. Techniques of EVT included stent retriever thrombectomy, stent retriever-assisted continuous aspiration, direct contact aspiration, and multimodal techniques including a rescue balloon mounted coronary stent placement. While one patient was noted to have petechial hemorrhage, no individuals developed parenchymal hematoma. Mean discharge NIHSS score was 1.7 (range 0-5). CONCLUSION:EVT is a safe and effective treatment for acute stroke secondary to LVO in this series of pregnant patients. While EVT for acute stroke is standard of care in select patient populations, our study suggests that treatment should be considered in the gravid population.

journal_name

J Neurointerv Surg

journal_title

Journal of neurointerventional surgery

authors

Limaye K,Van de Walle Jones A,Shaban A,Desai S,Al Kasab S,Almallouhi E,Holmstedt CA,Ortega-Gutierrez S,Haussen DC,Nogueira R,Mont'Alverne F,Ragiotto C,Rebello LC,Jovin TG,Hasan D,Jadhav A

doi

10.1136/neurintsurg-2019-015578

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

552-556

issue

eissn

1759-8478

issn

1759-8486

pii

neurintsurg-2019-015578

journal_volume

pub_type

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Endovascular management of acute large vessel occlusion stroke in pregnancy is safe and feasible.