RT Journal Article
SR Electronic
T1 Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2022-019590
DO 10.1136/jnis-2022-019590
A1 Jing Hong Loo
A1 Aloysius ST Leow
A1 Mingxue Jing
A1 Ching-Hui Sia
A1 Bernard PL Chan
A1 Raymond CS Seet
A1 Hock-Luen Teoh
A1 Lukas Meyer
A1 Jens Fiehler
A1 Panagiotis Papanagiotou
A1 Andreas Kastrup
A1 Anastasios Mpotsaris
A1 Volker Maus
A1 Furkan Yapici
A1 Davide Simonato
A1 Joseph D Gabrieli
A1 Giacomo Cester
A1 Pervinder Bhogal
A1 Oliver Spooner
A1 Christos Nikola
A1 Abhishek Joshi
A1 Tsong-Hai Lee
A1 Jiale Wu
A1 Yimin Chen
A1 Shuiquan Yang
A1 Vijay Kumar Sharma
A1 Benjamin YQ Tan
A1 Leonard LL Yeo
YR 2023
UL http://jnis.bmj.com/content/early/2023/01/05/jnis-2022-019590.abstract
AB Background The role of bridging intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in the treatment of acute ischemic stroke (AIS) remains debatable. Atrial fibrillation (AF) associated strokes may be associated with reduced treatment effect from IVT. This study compares the effect of bridging IVT in AF and non-AF patients.Methods This retrospective cohort study comprised anterior circulation large vessel occlusion (LVO) AIS patients receiving EVT alone or bridging IVT plus EVT within 6 hours of symptom onset. Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were successful reperfusion defined as expanded Thrombolysis In Cerebral Infarction (eTICI) grading ≥2b flow, symptomatic intracerebral hemorrhage (sICH), and in-hospital mortality.Results We included 705 patients (314 AF and 391 non-AF patients). The mean age was 68.6 years and 53.9% were male. The odds of good functional outcomes with bridging IVT was higher in the non-AF (adjusted odds ratio (aOR) 2.28, 95% CI 1.06 to 4.91, P=0.035) compared with the AF subgroups (aOR 1.89, 95% CI 0.89 to 4.01, P=0.097). However, this did not constitute a significant effect modification by the presence of AF on bridging IVT (interaction aOR 0.12, 95% CI −1.94 to 2.18, P=0.455). The rate of successful reperfusion, sICH, and mortality were similar between bridging IVT and EVT for both AF and non-AF patients.Conclusion The presence of AF did not modify the treatment effect of bridging IVT. Further individual patient data meta-analysis of randomized trials may shed light on the comparative efficacy of bridging IVT in AF versus non-AF LVO strokes.Data are available upon reasonable request.