Effect of atrial fibrillation on outcomes in patients with anterior circulation occlusion stroke receiving endovascular therapy

Wu, Weijuan; Rissardo, Jamir Pitton; Nguyen, Thanh N.; Mofatteh, Mohammad; Wei, Hongquan; Liebeskind, David S; Yang, Shuiquan; Wan-quan, LI; Pan, Wanling; Zhou, Shanshan; Lai, Yuzheng; Gao, Jianbao; Wang, Jian; Ouyang, Zhengqing; Mai, Yuzhen; Meng, Heng; Chen, Yimin; Liao, Xuxing

doi:10.3389/fnagi.2023.1160265

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…The presence of AF, as the comorbidity (OR: 1.533, 95% CI: 1.029–2.359) positively affected patient prognosis on the 90th day. The positive effect of AF on patient outcome after MT has been previously noted 30 , 35 , however, there are also studies indicating a negative effect of AF 22 , 36 , as well as the absence of an effect 16 , 24 , 37 . These discrepancies may be explained by the frequent use of anticoagulants in this disease, which may facilitate recanalization and, on the other hand, increase the likelihood of a bleeding complication.…”

Section: Discussionmentioning

confidence: 78%

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation—a single center study

Borończyk,

Kuźniak,

Borończyk

et al. 2024

Sci Rep

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Mechanical thrombectomy (MT) is the current standard treatment for strokes in the anterior cerebral circulation (AMT) and has recently been proven to be beneficial in the posterior circulation strokes (PMT). Our study aims to evaluate parameters for favorable outcomes in PMT-patients and to compare the clinical characteristics of individuals who received AMT and PMT. For this purpose, we confronted AMT and PMT-receipients and performed a multivariate regression analysis to assess the influence of factors on favorable outcomes in the study group and in the AMT and PMT subgroups. When analysing 623 MT-patients, those who received PMT had significantly lower admission National Institutes of Health Stroke Scale (NIHSS) scores (9 vs. 13; p < 0.001) and 24 h post-MT (7 vs. 12; p = 0.006). Key parameters influencing the favorable outcomes of PMT at discharge and at 90th day include: NIHSS scores (OR: 0.865, 95% CI: 0.813–0.893, and OR: 0.900, 95% CI: 0.861–0.925), MT time (OR: 0.993, 95% CI: 0.987–0.998 and OR: 0.993, 95% CI: 0.990–0.997), and leukocytosis (OR: 0.961, 95% CI: 0.928–0.988 and OR: 0.974, 95% CI: 0.957–0.998). Different clinical profiles exist between AMT and PMT-recipients, with the neurological status post-MT being decisive for the prognosis. Several factors play an important role in predicting outcome, especially in the PMT group.

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Section: Discussionmentioning

confidence: 78%

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation—a single center study

Borończyk,

Kuźniak,

Borończyk

et al. 2024

Sci Rep

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“…All studies were observational cohort studies, 8 , 10 , 11 , 12 , 13 , 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 comprising 16 096 patients with AIS (mean age, 70.1 years; women, 48.2%; 6862 with AF versus 9234 without AF). Five studies 12 , 23 , 24 , 25 , 27 provided propensity‐score matching data.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies 14 , 21 , 22 , 23 , 25 , 27 , 29 included patients with anterior and posterior circulation occlusions. Eight studies 8 , 10 , 11 , 12 , 26 , 28 , 30 , 31 included patients with anterior circulation occlusions only, 1 study 13 included patients with posterior circulation occlusions only, and 2 studies 20 , 24 did not provide the information of occluded vessels. Among the included studies, 9 11 , 12 , 13 , 22 , 23 , 27 , 28 , 29 , 30 were conducted in Asia‐Pacific populations, 8 studies 8 , 10 , 14 , 20 , 21 , 24 , 25 , 31 in Europe‐America populations, and only 1 26 in Asia‐Europe populations.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the studies adjusted for age, sex, and some if not all major comorbidity factors (hypertension, diabetes, dyslipidemia, and ischemic heart disease), and baseline National Institutes Health of Stroke Scale score. Four studies 10 , 22 , 27 , 29 adjusted for occlusion sites, and 6 studies 8 , 11 , 14 , 24 , 28 , 30 presented estimates that also adjusted for prior use of IVT and/or therapeutic anticoagulation.…”

Section: Resultsmentioning

confidence: 99%

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Atrial Fibrillation and Clinical Outcomes of Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta‐Analysis of Adjusted Effect Estimates

Zheng,

Tang,

Lin

et al. 2023

JAHA

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Background The impact of atrial fibrillation (AF) on the clinical outcomes in patients with acute ischemic stroke (AIS) who received endovascular thrombectomy remains unclear. We aimed to perform a meta‐analysis of adjusted effect estimates to examine the association between the presence of AF and the clinical outcomes in patients with AIS who received endovascular thrombectomy. Methods and Results We searched PubMed, Embase, and the Cochrane database between January 1, 2013 and July 10, 2023. Data were meta‐analyzed to compare the outcomes among patients with AIS with and without AF who received endovascular thrombectomy. Our primary outcome was 90‐day functional independence defined as a modified Rankin Scale score of 0 to 2. Secondary outcomes included excellent independence (90‐day modified Rankin Scale score of 0–1), 90‐day mortality, symptomatic intracranial hemorrhage, and any intracranial hemorrhage. Eighteen observational studies comprising 16 096 patients with AIS (mean age, 70.1 years; women, 48.2%; 6862 with AF versus 9234 without AF) were included. There were no statistically significant differences for modified Rankin Scale score of 0 to 2 (pooled odds ratio [OR], 1.14 [95% CI, 0.95–1.37]; [95% prediction interval [PI], 0.72–1.80]), mortality (OR, 0.92 [95% CI, 0.79–1.08]; [95% PI, 0.77–1.11]), symptomatic intracranial hemorrhage (OR, 0.97 [95% CI, 0.71–1.32]; [95% PI, 0.43–2.17]), and any intracranial hemorrhage (OR, 1.08 [95% CI, 0.91–1.28]; [95% PI, 0.74–1.58]) among patients with AIS with and without AF. Conclusions This meta‐analysis detected no significant differences in 90‐day functional outcomes, mortality, and intracerebral hemorrhage risk after endovascular thrombectomy in patients with AIS with and without AF. Registration URL: https://www.crd.york.ac.uk/prospero ; Unique identifier: CRD 42021293511.

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“…25 Results from the current study can be used in combination with other variables to build prognostic models to predict the outcome of EVT in stroke patients. [36][37][38] Time is brain; we should spare no effort to help reduce procedural times and LKNPT through workflow optimization with multidisciplinary collaboration, reduce infarct volume and early prediction to improve endovascular time metrics and patient outcomes. [39][40][41][42][43] DRT and PRT can be further shortened through the standardization of acute stroke workflows to improve patient outcomes.…”

mentioning

confidence: 99%

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

Liang,

Kwan,

et al. 2023

RMHP

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Purpose In this study, we aimed to determine whether post-Alberta Stroke Project Early CT Changes Score (post-ASPECTS) in anterior stroke and post-(posterior circulation) PC-ASPECTS in posterior stroke on CT can predict post-endovascular thrombectomy (EVT) functional outcomes among patients with acute ischemic stroke (AIS) after EVT. Patients and Methods A total of 247 consecutive patients aged 18 and over receiving EVT for LVO-related AIS were recruited into a prospective database. The data was retrospectively analyzed between March 2019 and February 2022 from two comprehensive tertiary care stroke centers: Foshan Sanshui District People’s Hospital and First People’s Hospital of Foshan in China. Patient parameters included EVT within 24 hr of symptom onset, premorbid modified Rankin scale (mRS) ≤2, presence of distal and terminal cerebral blood vessel occlusion, and subsequent 24–72-hr post-stroke onset CT scan. Univariate comparisons were performed using the Fisher's exact test or χ 2 test for categorical variables and the Mann–Whitney U -test for continuous variables. Logistic regression analysis was performed to further analyze for adjusting for confounding factors. A p-value of ≤0.05 was statistically significant. Results Overall, 236 individuals with 196 anterior circulation ischemic strokes and 40 posterior strokes of basilar artery occlusion were examined. Post-ASPECTS in anterior stroke and post-pc-ASPECTS as strong positive markers of favorable outcome at 90 days post-EVT; and lower rates of inpatient mortality/hospice discharge, 90-day mortality, and 90-day poor outcome were observed. Moreover, patients in the post-ASPECTS ≥ 7 cohort experienced shorter door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), and last known normal-to-puncture time (LKNPT). Conclusion Post-ASPECTS ≥7 in anterior circulation AIS and post-pc-ASPECTS ≥7 in posterior circulation can serve as strong prognostic markers of functional outcome after EVT.

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Effect of atrial fibrillation on outcomes in patients with anterior circulation occlusion stroke receiving endovascular therapy

Cited by 8 publications

References 24 publications

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation—a single center study

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation—a single center study

Atrial Fibrillation and Clinical Outcomes of Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta‐Analysis of Adjusted Effect Estimates

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

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