Increased intracranial hemorrhage of mechanical thrombectomy in acute ischemic stroke patients with atrial fibrillation

Huang, Kangmo; Zha, Mingming; Gao, Jie; Du, Juan; Li, Rui; Liu, Xinfeng

doi:10.1007/s11239-020-02269-3

Cited by 27 publications

(60 citation statements)

References 36 publications

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“…Among our patients, AF did not increase the risk of intracranial hemorrhagic complications. However, Huang et al (2021) showed a significant increase of ICB in AF patients after MT compared to those with no AF. This did not significantly influence their functional status or mortality at three months after stroke [25].…”

Section: Discussionmentioning

confidence: 74%

“…However, Huang et al (2021) showed a significant increase of ICB in AF patients after MT compared to those with no AF. This did not significantly influence their functional status or mortality at three months after stroke [25]. In general, MT is considered to be safe in terms of the risk of increased ICB in patients given anticoagulant treatment [26][27][28][29].…”

Section: Discussionmentioning

confidence: 74%

“…In general, MT is considered to be safe in terms of the risk of increased ICB in patients given anticoagulant treatment [26][27][28][29]. However, there are studies which indicate that AF increases the risk of ICB even in patients with low INR [25]. The presented study also evaluated the potential influence of prior anticoagulant therapy; it did not show any relationship with the parameters.…”

Section: Discussionmentioning

confidence: 86%

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Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

Lasek–Bal

Binek

Żak

et al. 2021

JCM

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To date, inconsistent results evaluating the effect of parameters on mechanical thrombectomy (MT) outcomes in stroke-patients have been published. This study aimed to identify the key parameters for functional status after MT in stroke-patients in short and long-term follow-up. Method: The study analysis focused on the relevance of selected clinical and non-clinical parameters to the functional status of the patients after MT. Results: 417 stroke-patients (mean age 67.8 ± 13.2 years) were qualified. Atrial fibrillation, and leukocytosis were significant for the neurological status on the first day of stroke (p = 0.036, and p = 0.0004, respectively). The parameters with the strongest effect on the functional status on day 10 were: age (p = 0.009), NIHSS (p = 0.002), hyperglycemia (p = 0.009), the result in TICI (p = 0.046), and first pass effect (p = 0.043). The parameters with the strongest effect on the functional status on day 365 were: age and NIHSS on the first day of stroke (p = 0.0002 and 0.002, respectively). Leukocytosis and the neurological status at baseline were key parameters associated with ICB after MT (p = 0.007 and p = 0.003, respectively). Conclusions: Age and neurological status in the ultra-acute phase of stroke are crucial for the functional status in short and long-term observations of patients treated with mechanical thrombectomy. Atrial fibrillation, hyperglycemia, and inflammatory state are relevant to the short-term post-stroke functional status. First pass effect and the degree of post-interventional reperfusion are important technical parameters to the short-term functional status. Neurological status and white blood count during the acute phase are associated with a high rate of post-procedural intracranial bleeding.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 86%

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Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

Lasek–Bal

Binek

Żak

et al. 2021

JCM

View full text Add to dashboard Cite

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“…This is probably mainly due to the fact that patients with AF are more likely to taking oral anticoagulants, which is a contraindication for the administration of tPA [ 17 ]. Conversely, a post-hoc analysis of a multi-center head-to-head clinical trial revealed that AF was an independent risk factor for any ICH in AIS patients undergoing stent-retriever thrombectomy, which was partly attributable to the adjusted anticoagulation status and more retrieval attempts by mediation analyses [ 18 ]. Furthermore, a national registry study assessing post-thrombectomy outcomes found no difference in either in-hospital or discharge outcomes between matched patients with or without AF, [ 19 ] whereas two other studies suggested faster procedural time, fewer passes, higher rates of first pass effect, successful reperfusion and good functional outcome with AF-related stroke [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous observations found patients with AIS caused by AF tend to have more bleedings and worse outcomes after EVT than those without AF [ 16 , 18 ]. However, special cautions should be taken when interpreting these results, such a statement could lead to misconclusions to suspecting or even denying EVT to patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study

Tong

Liu

et al. 2021

BMC Neurol

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Background and objective The effect of atrial fibrillation (AF) on outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) is controversial. This study aimed to investigate the association of AF with outcomes after EVT in AIS patients. Methods Subjects were selected from ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) - a prospective consecutive cohort of AIS patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and then grouped according to having a history of AF or not. After 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale (mRS) score, successful recanalization after final attempt, symptomatic intracranial hemorrhage (ICH) within 24 h, and death within 90 days were compared. Results A total of 1755 patients, 550 with AF and 1205 without AF, were included. Among 407 pairs of patients identified after matching, no significant differences were found in the mRS score (median: 3 vs. 3 points; P = 0.29), successful recanalization (87.2 vs. 85.3%; P = 0.42), symptomatic ICH (9. 4 vs. 9.1%; P = 0.86) and death (16.3 vs. 18.4%; P = 0.44) between patients with and without AF. Conclusion The findings of this matched-control study show comparable outcomes of EVT in Chinese AIS patients with and without AF, which do not support withholding EVT in patients with both AIS and AF. Trial registration NCT03370939 First registration date: 28/09/2017 First posted date: 13/12/2017

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Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

et al. 2023

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ImportancePatients with atrial fibrillation (AF) treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) have been reported to experience worse outcomes compared with patients without AF.ObjectiveTo assess differences between patients with AF and their counterparts without AF treated with MT for AIS, focusing on safety outcomes, clinical outcomes, and baseline characteristics in both groups.Data SourcesA systematic literature review of the English language literature from inception to July 14, 2022, was conducted using Web of Science, Embase, Scopus, and PubMed databases.Study SelectionStudies that focused on patients with and without AF treated with MT for AIS were included. Multiple reviewers screened studies to identify studies included in analysis.Data Extraction and SynthesisData were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline to ensure accuracy. Data were pooled using a random-effects model.Main Outcomes and MeasuresThe primary outcome of interest was rate of modified Rankin Scale (mRS) scores of 0 to 2 at 90 days. Secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction (TICI) scores of 2b to 3, 90-day mortality, symptomatic intracranial hemorrhage (SICH), and baseline patient characteristics.ResultsOf 1696 initially retrieved studies, 10 studies were included, with 6543 patients. Patients with AF were a mean of 10.17 (95% CI, 8.11-12.23) years older (P &lt; .001) and had higher rates of hypertension (OR, 1.89 [95% CI, 1.57-2.27]; P &lt; .001) and diabetes (OR, 1.16 [95% CI, 1.02-1.31]; P = .02). Overall, there were comparable rates of mRS scores of 0 to 2 between patients with AF and patients without AF (odds ratio [OR], 0.72 [95% CI, 0.47-1.10]; P = .13), with significant heterogeneity among the included studies. After sensitivity analysis, the rate of mRS scores of 0 to 2 was significantly lower among patients with AF (OR, 0.65 [95% CI, 0.52-0.81]; P &lt; .001). Successful reperfusion rates were similar between the groups (OR, 1.11 [95% CI, 0.78-1.58]; P = .57). The rate of SICH was similar between groups (OR, 1.05 [95% CI, 0.84-1.31]; P = .68). Mortality was significantly higher in the AF group (OR, 1.47 [95% CI, 1.12-1.92]; P = .005).Conclusions and RelevanceIn this systematic review and meta-analysis, patients with AF experienced worse 90-day outcomes, even in the setting of similar rates of successful reperfusion. This was likely associated with greater age and greater rates of comorbidities among patients with AF.

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Increased intracranial hemorrhage of mechanical thrombectomy in acute ischemic stroke patients with atrial fibrillation

Cited by 27 publications

References 36 publications

Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study

Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

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