Background In the SWIFT randomized trial, neurothrombectomy with SOLITAIRE Flow Restoration device (SOLITAIRE) compared with the MERCI Retriever was superior in achieving the primary endpoint, successful recanalization without use of rescue therapy or symptomatic intracranial hemorrhage (SRNH), and was associated with improved outcomes on secondary clinical endpoints, including reduced mortality and higher rates of good neurological outcome at 3 months. Both treatment arms were generally well-matched on baseline characteristics, but an imbalance in the frequency of atrial fibrillation was noted. To minimize potential confounding by this imbalance, we undertook an analysis of trial primary and secondary outcomes confined to the subset of patients in SWIFT with atrial fibrillation.
Methods Multicenter RCT with blinded primary endpoint ascertainment. Key entry criteria: age 22–85; NIHSS 8–29; within 8 h of onset; ineligible or failed IV TPA; intracranial ICA, M1, M2, BA, or VA occlusion.
Results The total SWIFT study population, enrolled at 18 sites, comprised 144 patients, including 31 roll-in phase SOLITAIRE patients and 113 randomized patients, 58 SOLITAIRE, 55 MERCI. Among these patients, randomized patients, SOLITAIRE and MERCI treatment arms were comparable on 27 baseline demographic and medical history variables, including age, NIHSS, and onset to treatment time, but differed in history of atrial fibrillation (p=0.02). History of atrial fibrillation was present in 75/144 (52.1%) trial patients, including 12/31 (38.7%) roll-in SOLITAIRE patients, 26/58 (44.8%) randomized SOLITAIRE patients and 37/55 (67.3%) randomized MERCI patients. Outcome findings among the patients with atrial fibrillation are shown in the Abstract P-007 table 1.
Conclusions Among patients with atrial fibrillation, the SOLITAIRE Flow Restoration device was superior to the MERCI Retriever in achieving successful recanalization free of symptomatic hemorrhagic transformation, reduced mortality, and more frequent good final neurologic outcomes.
Competing interests J Saver: Covidien. R Jahan: Covidien. E Levy: Covidien. T Jovin: Covidien. B Baxter: Covidien. R Nogueira: Covidien. W Clark: Covidien. R Budzik: Covidien. O Zaidat: Covidien. For the SWIFT Trialists: Covidien.
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