RT Journal Article
SR Electronic
T1 Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 883
OP 888
DO 10.1136/neurintsurg-2020-016720
VO 13
IS 10
A1 Akbik, Feras
A1 Alawieh, Ali
A1 Cawley, C Michael
A1 Howard, Brian M
A1 Tong, Frank C
A1 Nahab, Fadi
A1 Saad, Hassan
A1 Dimisko, Laurie
A1 Mustroph, Christian
A1 Samuels, Owen B
A1 Pradilla, Gustavo
A1 Maier, Ilko
A1 Goyal, Nitin
A1 Starke, Robert M
A1 Rai, Ansaar
A1 Fargen, Kyle M
A1 Psychogios, Marios N
A1 Jabbour, Pascal
A1 De Leacy, Reade
A1 Giles, James
A1 Dumont, Travis M
A1 Kan, Peter
A1 Arthur, Adam S
A1 Crosa, Roberto Javier
A1 Gory, Benjamin
A1 Spiotta, Alejandro M
A1 Grossberg, Jonathan A
A1 ,
YR 2021
UL http://jnis.bmj.com/content/13/10/883.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.