State-of-the-Art Review
Similarities and Differences Between Primary Percutaneous Coronary Intervention and Mechanical Thrombectomy

https://doi.org/10.1016/j.jcin.2020.03.055Get rights and content
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Highlights

  • Properly trained interventional cardiologists can be an asset given the high demand for MT.

  • Interventional cardiologists must be familiar with technical aspects of MT and the AIS worklfow.

  • More cooperation among specialties will be key for reducing the societal burden of stroke.

Abstract

Acute ischemic stroke is among the leading causes of mortality and disability worldwide. Since 2015, as was the case for primary percutaneous coronary intervention for acute myocardial infarction, catheter-based reperfusion via mechanical thrombectomy (MT) has become the gold-standard treatment for acute ischemic stroke caused by large-vessel occlusion. Despite that, only a fraction of the world’s population currently would be able to undergo MT in time, mostly because of the scarcity of 24/7 coverage by neurointerventionalists to deal with this enormous burden. Interventional cardiologists have thus been considered a logical option to aid in combating this vast demand to diminish the burden of acute ischemic stroke. However, despite some seemingly evident similarities between primary percutaneous coronary intervention and MT, for interventional cardiologists to enter this new field, they must be well trained and fully aware of all the clinical, technical, and environmental differences between these two scenarios. The main objective of this state-of-the-art paper is to serve as an introductory and comprehensive guide to familiarize the interventional cardiology community with the most critical technical aspects of MT.

Key Words

acute ischemic stroke
interventional cardiologist
large vessel occlusion
mechanical thrombectomy
primary percutaneous coronary intervention

Abbreviations and Acronyms

ADAPT
a direct aspiration first-pass technique
AIS
acute ischemic stroke(s)
ASPECTS
Alberta Stroke Programme Early CT Score
CT
computed tomography
ICA
internal carotid artery
LVO
large-vessel occlusion
MCA
middle cerebral artery
MT
mechanical thrombectomy
NIHSS
National Institutes of Health Stroke Scale
PPCI
primary percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TLKW
time last known well

Cited by (0)

Dr. Martins contributes to and receives grants from GE Healthcare for lecturing on mechanical thrombectomy for the SPREAD MT course in mechanical thrombectomy for interventional cardiologists. Dr. Hopkins has received grant and research support from Canon Medical Systems; has financial interests or stock in Boston Scientific, Cerebrotech, Endostream, Endomation, Silk Road, Ostial Corporation, Imperative Care, StimSox, Photolitec, ValenTx, Ellipse, Axtria, NextPlain, and Ocular; holds a board/trustee/officer position in Imperative Care; and has a financial interest and holds a board position in Vastrax, a clinical trials management company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.