Safety and efficacy of continuous intra-arterial infusion of heparin administration in mechanical thrombectomy for acute ischemic stroke: a single-center retrospective study

TL;DR

This study finds that continuous intra-arterial heparin infusion during stroke treatment may improve patient outcomes without increasing risks.

Contribution

The study introduces a novel method of continuous intra-arterial heparin infusion during mechanical thrombectomy for stroke.

Findings

Continuous intra-arterial heparin infusion was associated with higher functional independence rates.

The method did not increase risks of bleeding or other complications.

Anticoagulant therapy during hospitalization was a protective factor against poor outcomes.

Abstract

The use of heparin during mechanical thrombectomy (MT) for acute large vessel occlusion ischemic stroke (LVO-AIS) is controversial, with no unified standard on its administration methods and efficacy. This study aims to investigate the effectiveness and safety of continuous intra-arterial infusion of heparin administration during MT in real-world practice.

A single-center retrospective study included consecutive LVO stroke patients treated with mechanical thrombectomy at Chongqing University Central Hospital (August 2022–January 2024). Participants were stratified by intraprocedural heparin administration: (1) arterial heparin Group-continuous intra-arterial heparinization via high-pressure infusion (Heparin 1,000 IU was diluted in 500 ml of 0.9% sodium chloride solution and connected to both the guiding catheter and the intermediate catheter. The infusion bag was replaced as needed according to the duration of the procedure) at a conventional drip rate; (2) non-additional heparin Group-standard heparin solution flushing withoutusing additional anticoagulant. The main outcome were 3-months functional independence, defined as a modified Rankin Scale (mRS) ≤ 2. The main Safety outcome were defined as symptomatic intracranial hemorrhage (sICH) in 24 h.

A total of 98 patients were eligible for analysis: 54 in the Arterial heparin Group and 44 in the Non-additional heparin Group. Continuous intra-arterial infusion of heparin administration during MT had a higher rates of functional independence (57.4 vs. 36.4%, adjusted P = 0.035), no significant impact on recanalization rate, sICH, distal embolization, or mortality (adjusted P > 0.05). However, the admission NIHSS score [odds ratio 1.225 (1.096–1.370), P < 0.01] was identified as independent predictor of unfavorable outcomes, while anticoagulant therapy during hospitalization [odds ratio 0.209 (0.067–0.653), P < 0.01] was a protective factor. Aspiration was a protective factor against sICH [odds ratio 0.009 (0.00–0.845), P = 0.042].

Our study suggests that continuous intra-arterial infusion of heparin administration during mechanical thrombectomy for acute large vessel occlusion ischemic stroke may be safe and is associated with higher rates of favorable outcomes. Further prospective research is needed to validate these findings.

Figures