Outcomes of mechanical thrombectomy in anticoagulated patients with acute distal and medium vessel stroke
Authors: Salim Hamza , Musmar Basel , Adeeb Nimer , Yedavalli Vivek , Lakhani Dhairya , Grewal Sahibjot Singh , El Naamani Kareem , Henninger Nils , Sundararajan Sri Hari , Kühn Anna Luisa , Khalife Jane , Ghozy Sherief , Scarcia Luca , Tan Benjamin YQ , Regenhardt Robert W , Heit Jeremy J , Cancelliere Nicole M , Bernstock Joshua D , Rouchaud Aymeric , Fiehler Jens , Sheth Sunil , Puri Ajit S , Dyzmann Christian , Colasurdo Marco , Barreau Xavier , Renieri Leonardo , Filipe João Pedro , Harker Pablo , Radu Răzvan Alexandru , Abdalkader Mohamad , Klein Piers , Marotta Thomas R , Spears Julian , Ota Takahiro , Mowla Ashkan , Jabbour Pascal , Biswas Arundhati , Clarençon Frédéric , Siegler James E , Nguyen Thanh N , Varela Ricardo , Baker Amanda , Essibayi Muhammed Amir , Altschul David , Gonzalez Nestor R , Möhlenbruch Markus A , Costalat Vincent , Gory Benjamin , Stracke Christian Paul , Aziz-Sultan Mohammad Ali , Hecker Constantin , Shaikh Hamza , Liebeskind David S , Pedicelli Alessandro , Alexandre Andrea M , Tancredi Illario , Faizy Tobias D , Kalsoum Erwah , Lubicz Boris , Patel Aman B , Pereira Vitor Mendes , Guenego Adrien , Dmytriw Adam A , Amllay Abdelaziz , Vagal Achala , ter Schiphorst Adrien , Thomas Ajith J. , Gopinathan Anil , Dusart Anne , Capirossi Carolina , Mounayer Charbel , Weyland Charlotte , Hsieh Cheng-Yang , Griessenauer Christoph J. , Stapleton Christopher J. , Kalsoum Erwah , Bellante Flavio , Marnat Gaultier , Forestier Géraud , Shaikh Hamza , Cuellar-Saenz Hugo H. , Valente Iacopo , Sibon Igor , Rabinov James D. , Berge Jérôme , Jesser Jessica , Carlos Martinez-Gutierrez Juan , Premat Kevin , Yeo Leonard LL. , Chervak Lina , Meyer Lukas , Elhorany Mahmoud , Quintero-Consuegra Miguel 
Published: May 2024

Background: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood. Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023. Data on demographics, clinical presentation, treatment specifics, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications. Results: Of the patients, 223 (34%) were on anticoagulation therapy. Anticoagulated patients were older (median age 78 vs 74 years; p < 0.001) and had a higher prevalence of atrial fibrillation (77% vs 26%; p < 0.001). Their baseline National Institutes of Health Stroke Scale (NIHSS) scores were also higher (median 12 vs 9; p = 0.002). Before propensity score matching (PSM), anticoagulated patients had similar rates of favorable 90-day outcomes (mRS 0–1: 30% vs 37%, p = 0.1; mRS 0–2: 47% vs 50%, p = 0.41) but higher mortality (26% vs 17%, p = 0.008). After PSM, there were no significant differences in outcomes between the two groups. Conclusion: Anticoagulated patients undergoing MT for AIS due to DMVO did not show significant differences in 90-day mRS outcomes, reperfusion, or hemorrhage compared to non-anticoagulated patients after adjustment for covariates.