Influence of atrial fibrillation detection time on outcome after endovascular thrombectomy

Leker, Ronen R.; Farraj, A.; Filioglo, Andrei; Sacagiu, Tzvika; Honig, Asaf; Gomori, John M.; Cohen, José E.

doi:10.1016/j.jns.2020.117189

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…This is an important observation regarding the safety of MT in patients with LVO stroke related to AF. In line with the present multicenter experience, 25-50% of patients undergoing MT suffer from AF and as much as half of these have been using anticoagulation treatment in the period of stroke onset [12,20,22,23,25].…”

Section: Discussionsupporting

confidence: 74%

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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: Discussionsupporting

confidence: 74%

“…To date, inconsistent results evaluating the effect of DM and AF on MT outcomes have been published [13,15]. AF is a common cause of LVO that necessitates endovascular treatment [9,[20][21][22]. MR CLEAN sub-analysis failed to confirm a significant effect of AF on MT outcomes [23,24].…”

Section: Discussionmentioning

confidence: 99%

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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“…[6,9] To date, it has been demonstrated by many authors that AF-associated stroke shows greater morphological damage to the neural tissue, a higher risk of hemorrhagic transformation, a more severe clinical course and a poorer functional status of patients with higher mortality in the acute period and at 12 months. [4][5][6][7][8][9][10][11][12][13][14][15][16]22,29,30] In the presented study, AF patients were older and more often in poor functional status at 3 time-points of functional status assessment than to those with no arrhythmias. They were more often subjected to hemicraniectomy due to a deteriorated clinical status and poorer neuroimaging findings.…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of stroke patients with comorbid AF undergoing MT is 25-50% as per the experience of other centers. [6][7][8][9]11] Until recently, some centers deemed patients ineligible for MT if their INR > 3. According to current recommendations, that is not a barrier value.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] The relevance of atrial fibrillation (AF) to the effect of thrombectomy is undetermined and the results of several studies are inconsistent. [2,[6][7][8][9][10][11] The disease affects 28-50% of all stroke patients undergoing MT. [6,12] AF in stroke patients is an independent factor for a poorer functional status and increased mortality within the first year after stroke.…”

Section: Introductionmentioning

confidence: 99%

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The relevance of atrial fibrillation to the safety and efficacy of mechanical thrombectomy in stroke patients

Lasek–Bal¹,

Żak²,

Binek³

et al. 2021

Polish Archives of Internal Medicine

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Our study demonstrated a neutral impact of AF on the safety and efficacy of mechanical thrombectomy in the ultra-acute phase of stroke (≤ 6 hours from onset). Exposure to anticoagulant therapy preceding stroke does not significantly increase the risk of symptomatic intracranial bleeding after mechanical thrombectomy, which is also true for patients with INR in the therapeutic range. We identified the crucial parameters for the functional post-stroke status in AF-related stroke patients on days 10, 30 and 90 following mechanical thrombectomy. These parameters include age, the neurological status on the first day of stroke, and the result of post-interventional reperfusion (according to TICI scale).

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Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

D’Anna,

Ornello,

Foschi

et al. 2023

J Thromb Thrombolysis

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We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.

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Influence of atrial fibrillation detection time on outcome after endovascular thrombectomy

Cited by 6 publications

References 21 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

The relevance of atrial fibrillation to the safety and efficacy of mechanical thrombectomy in stroke patients

Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

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