Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

• Type of Material: Article
• Authors: Feras Akbik, Emory University; Ali Alawieh, Emory University; Charles Cawley, Emory University; Brian Howard, Emory University; Frank Tong, Emory University; Fadi Nahab, Emory University; Hassan Saad, Emory University; Laurie Dimisko, Emory Healthcare; Christian Mustroph, Emory University; Owen Samuels, Emory University; Gustavo Pradilla, Emory University; Ilko Maier, University Medicine Goettingen; Nitin Goyal, University of Tennessee Health Science Center; Robert M Starke, University of Miami; Ansaar Rai, West Virginia University Hospitals; Kyle M Fargen, Wake Forest University; Marios N Psychogios, University Hospital Basel; Pascal Jabbour, Thomas Jefferson University; Reade De Leacy, Icahn School of Medicine at Mount Sinai; James Giles, Washington University; Travis M Dumont, University of Arizona; Peter Kan, Baylor College of Medicine; Adam S Arthur, Semmes-Murphey Neurologic and Spine Institute; Roberto Javier Crosa, Médica Uruguaya; Benjamin Gory, CHRU Nancy; Alejandro M Spiotta, Medical University of South Carolina; Jonathan Grossberg, Emory University
• Language: English
• Date: 2021-10-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021, The Author(s). Published by BMJ Publishing Group Ltd.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/neurintsurg-2020-016720
• Title of Journal or Parent Work: JOURNAL OF NEUROINTERVENTIONAL SURGERY
• Volume: 13
• Issue: 10
• Start Page: 883
• End Page: 888
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: Science & Technology; thrombectomy; stroke; DEATH; ETIOLOGY; Surgery; thrombolysis; Life Sciences & Biomedicine; Neuroimaging; PREDICTOR; Neurosciences & Neurology; HEMORRHAGIC TRANSFORMATION; OUTCOMES; ACUTE ISCHEMIC-STROKE; hemorrhage

Abstract

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.