Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy
| Autor: | Benjamin Yong-Qiang Tan, Gopinathan Anil, Kian Keong Poh, Nicholas Jh Ngiam, Vijay Sharma, Staffan Holmin, Leonard L.L. Yeo, Bernard P.L. Chan, Yang Cunli, Ching-Hui Sia, Tommy Anderssen |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
030204 cardiovascular system & hematology Endovascular therapy Brain Ischemia 03 medical and health sciences 0302 clinical medicine Ischemia Internal medicine Ischaemic stroke Humans Medicine In patient Endovascular treatment Aged Ischemic Stroke Retrospective Studies Thrombectomy Acute stroke business.industry Endovascular Procedures Aortic Valve Stenosis medicine.disease Functional recovery Stroke Stenosis Treatment Outcome Heart failure cardiovascular system Cardiology business 030217 neurology & neurosurgery |
| Zdroj: | Interv Neuroradiol |
| ISSN: | 2385-2011 1591-0199 |
| DOI: | 10.1177/1591019920920988 |
| Popis: | Background and aim Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke. Methods Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area 2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months. Results We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation. Conclusion In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further. |
| Databáze: | OpenAIRE |
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