You are here

Article Text

Article menu
Download PDFPDF
Ischemic stroke
Original research
Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion
  1. Presaad Pillai1,2,
  2. Steven J Bush3,
  3. Yohanna Kusuma1,
  4. Leonid Churilov4,
  5. Richard J Dowling3,
  6. Vu Dang Luu5,
  7. Stephen M Davis1,
  8. Peter J Mitchell3,
  9. Bernard Yan1
  1. 1 Department of Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Neurology Unit, Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
  3. 3 Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Melbourne Medical School, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam
  1. Correspondence to Bernard Yan, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Bernard.yan{at}mh.org.au

Abstract

Background First pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related strokes have different clot composition compared with non-AF strokes, which may impact thrombectomy reperfusion results. We compared FPE rates in AF and non-AF stroke patients to evaluate if AF-related strokes had higher FPE rates.

Methods We conducted a post-hoc analysis of the DIRECT-SAFE trial data, including patients with retrievable clots on the initial angiographic run. Patients were categorized into AF and non-AF groups. The primary outcome was the presence or absence of FPE (single-pass, single-device resulting in complete/near complete reperfusion) in AF and non-AF groups. We used multivariable logistic regression to examine the association between FPE and AF, adjusting for thrombolysis pre-thrombectomy and clot location.

Results We included 253 patients (67 with AF, 186 without AF). AF patients were older (mean age: 74 years vs 67.5 years, p=0.001), had a higher proportion of females (55% vs 40%, p=0.044), and experienced more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) score: 17 vs 14, p=0.009) than non-AF patients. No differences were observed in thrombolytic agent usage, time metrics, or clot location. AF patients achieved a higher proportion of FPE compared with non-AF patients (55.22% vs 37.3%, adjusted odds ratio 2.00 (95% CI 1.13 to 3.55), p=0.017).

Conclusions AF-related strokes in LVO patients treated with EVT were associated with FPE. This highlights the need for preparedness for multiple passes and potential adjuvant/rescue therapy in non-AF-related strokes.

  • Angiography
  • Stroke
  • Technique
  • Thrombectomy
  • Vessel Wall

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-020512

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Footnotes

    • X @presaadpillai

    • Correction notice Since this paper first published online, the headings in table 3 have switched. Direct thrombectomy is now the left hand heading and Bridging therapy is on the right. This does not affect any of the other results or the authors conclusions.

    • Contributors Study conception and design: BY, PJM. Article drafting: PP, BY, LC. Acquisition of data/data analysis: PP, BY, LC. Review, revision, and final approval of article prior to submission: all authors. Study supervision: BY. Guarantor: BY

    • 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 None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.