Thrombectomy a viable first-line therapy for stroke in pregnant women, new mothers

In the treatment of women with acute ischaemic stroke (AIS), mechanical thrombectomy (MT) is effective and can be safely performed during pregnancy or the postpartum period, as shown in a study.

“In comparison with nonpregnant female patients treated with MT, pregnant or postpartum patients [had] lower rates of both intracranial haemorrhage (11 percent vs 24 percent; p=0.069) and poor functional outcome (50 percent vs 72 percent; p=0.003) at discharge,” according to the investigators.

“[O]ur findings suggest that [MT] is a viable and safe first-line therapy. Although retrospective data evaluating treatment modalities must be validated by prospectively designed clinical trials, the rarity of AIS in the setting of pregnancy and the postpartum period makes such an undertaking unlikely,” they said, adding that large-scale cross-sectional analyses such as the present study should provide valuable clinical insight in the absence of prospective clinical trials.

The study identified 52,825 female patients hospitalized for AIS over a 7-year study period (from 2012 to 2018) in the US, among whom 180 of 4,590 pregnant or postpartum women were treated with MT. The investigators compared 180 MT-treated pregnant/postpartum patients and 48,055 nonpregnant female patients with stroke also treated with MT in the first branch of the analysis. In the second branch, pregnant/postpartum patients treated with MT were compared with their counterparts who were treated with medical management only (n=4,410).

Significantly fewer pregnant vs nonpregnant patients with AIS treated with MT developed intracranial haemorrhage (11 percent vs 24 percent; p=0.069) and had poor functional outcome (50 percent vs 72 percent; p=0.003) at discharge. [Stroke 2021;doi:10.1161/STROKEAHA.121.034303]

Pregnant/postpartum status showed an independent association with a lower likelihood of intracranial haemorrhage (adjusted odds ratio, 0.26, 95 percent confidence interval, 0.09–0.70; p=0.008). However, compared with medically managed pregnant and postpartum patients, their MT-treated counterparts had greater rates of venous thromboembolism (17 percent vs 0 percent; p=0.001) and complications related to pregnancy (44 percent vs 64 percent; p=0.034). Meanwhile, there was no significant differences seen in the frequency of postpartum complications, functional outcome at discharge, or hospital length of stay.

“Given that pregnant/postpartum women are already predisposed to hypercoagulability and general immobility, it follows that those enduring on-balance longer hospital stays following treatment with MT may also experience higher rates of deep venous thrombosis and pulmonary embolism,” the investigators pointed out.

“Indeed, the risk of these complications following ischaemic stroke is compounded by restricted mobility and clotting disorders, as is the case in this cohort. These findings highlight a potential need to monitor for thromboembolic complications in pregnant and postpartum patients with stroke treated with endovascular therapy,” they added. [Curr Treat Options Neurol 2011;13:629-635]