Background Atrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).
Objective To determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.
Methods We performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom 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 (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).
Conclusions In patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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FA and AA contributed equally.
AMS and JAG contributed equally.
Collaborators Stroke Thrombectomy and Aneurysm Registry (STAR): Jan Liman; David J Mccarthy; Vasu Saini; Stacey Q Wolfe; J Mocco; Johanna T Fifi; Fábio A Nascimento; Ahmad Sweid; Salah G Keyrouz; Wuwei Feng; Reda M Chalhoub; Sébastien Richard; Brian Hoh; Adam Polifka; Min Park; Kimberly Kicielinski; Sami Al Kasab; Eyad Almallouhi; Michelle Allen; Jonathan Lena; Daniel A Hoit; Lucas Elijovich; Violiza Inoa; Christopher Nickele.
Contributors FA, AA, JAG, and AMS designed the project, acquired data, analyzed the data, and wrote the manuscript. CMC, BMH, FCT, FN, HS, LD, CM, OBS, and GP contributed to data acquisition, interpretation, and critical review. IM, NG, RMS, AR, KMF, MNP, PJ, RDL, JG, TMD, PK, ASA, RJC, and BG contributed to data interpretation and critical review of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RMS: consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus. MNP: travel grants/honoraria–Phenox, Stryker, Siemens. ASA: consultant–Balt, Johnson and Johnson, Leica, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker; research support–Cerenovus, Microvention, Penumbra, and Siemens; and shareholder–Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, Vascular Simulations. PJ: consultant-Medtronics, Microvention. AMS: consultant–Penumbra, Microvention, and Pulsar Vascular; travel grants/honoraria–Penumbra, Pulsar Vascular, Microvention, Stryker. AR: consulting agreement with Stryker, Cerenovus, and Microvention.
Provenance and peer review Not commissioned; internally peer reviewed.