(Continued authors) Johanna T Fifi, Fábio A Nascimento, Ahmad Sweid, James A Giles, Roberto Crosa, W Christopher Fox, Benjamin Gory, Alejandro M Spiotta, and Jonathan A Grossberg, on behalf of Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators.
Background Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis. The effect of AF on procedural and clinical outcomes after mechanical thrombectomy, with or without bridging therapy, remains unexplored. Here we determine whether recanalization efficacy, procedural speed, and hemorrhagic complications differ in AF associated stroke treated with mechanical thrombectomy and bridging therapy.
Methods We performed a retrospective cohort study of the Stroke and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4,169 patients who underwent thrombectomy for an anterior circulation stroke, 1,517 (36.4%) of which had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.
Results AF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis. AF was only associated with increased odds of intracranial hemorrhage in mechanical thrombectomy patients exposed to bridging therapy with intravenous thrombolysis (aOR 2.08, 1.06–4.06, p<0.033). In these patients, bridging therapy did not improve functional outcomes. In patients without AF, bridging therapy did improve outcomes (aOR 1.32, 1.02–1.74, p<0.05) without increased hemorrhagic complications.
Conclusions In patients treated with mechanical thrombectomy, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage. These results are in contrast to the increased hemorrhage rates reported in AF associated stroke treated with supportive care and or intravenous thrombolysis. Bridging therapy in AF patients undergoing thrombectomy independently increased the odds of intracranial hemorrhage and did not improve functional outcomes. Together, these results suggest that AF associated stroke has a differential response to intravenous thrombolysis and mechanical thrombectomy. Randomized trials are warranted to determine whether patients with AF associated stroke may benefit by deferring bridging therapy at thrombectomy-capable centers.
Disclosures F. Akbik: None. A. Alawieh: None. C. Cawley: None. B. Howard: None. F. Tong: None. F. Nahab: None. F. Nahab: None. H. Saad: None. L. Dimisko: None. O. Samuels: None. G. Pradilla: None. I. Maier: None. W. Feng: None. R. Chalhoub: None. N. Goyal: None. R. Starke: None. A. Rai: None. K. Fargen: None. M. Psychogios: None. P. Jabbour: None. R. De Leacy: None. S. Keyrouz: None. T. Dumont: None. P. Kan: None. J. Liman: None. A. Arthur: None. D. Mccarthy: None. V. Saini: None. S. Wolfe: None. J. Mocco: None.
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