Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

Alobaida, Muath; Harrison, Stephanie L; Lane, Deirdre A.; Underhill, Paula; Hill, Andrew; Lip, Gregory Y. H.

doi:10.1016/j.jstrokecerebrovasdis.2022.106917

Cited by 5 publications

(15 citation statements)

References 20 publications

(19 reference statements)

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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. Seven studies 14 , 21 , 22 , 23 , 25 , 27 , 29 included patients with anterior and posterior circulation occlusions.…”

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%

“…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. Four studies 8 , 21 , 24 , 25 were large sample size (n>1500). Essential characteristics of the study cohort are summarized in Table 1 and Table S1 .…”

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…This data is critical to develop evidence-based policy to guide resource allocation for AF screening, stroke prevention and lifestyle-related interventions [ 5 , 32 ]. Despite the use of reperfusion therapy, it is also not clear how AF impacts the effectiveness of these treatments [ 33 , 34 ]. Resolving this uncertainty holds paramount importance in devising optimal treatment strategies, as well as for risk stratification and prognosis communication with patients [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes—A Comprehensive Systematic Review and Meta-Analysis

Patel,

Bhaskar

2023

Neurology International

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Atrial fibrillation (AF) significantly contributes to acute ischaemic stroke (AIS), yet its precise influence on clinical outcomes post-intravenous thrombolysis (IVT) and post-endovascular thrombectomy (EVT) has remained elusive. Furthermore, the overall prevalence of AF in AIS patients undergoing reperfusion therapy has not been clearly determined. Employing random-effects meta-analyses, this research aimed to estimate the pooled prevalence of AF among AIS patients undergoing reperfusion therapy, while also examining the association between AF and clinical outcomes such as functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. Studies comparing AF and non-AF patient groups undergoing reperfusion therapy were identified and included following an extensive database search. Forty-nine studies (n = 66,887) were included. Among IVT patients, the prevalence of AF was 31% (Effect Size [ES] 0.31 [95%CI 0.28–0.35], p < 0.01), while in EVT patients, it reached 42% (ES 0.42 [95%CI 0.38–0.46], p < 0.01), and in bridging therapy (BT) patients, it stood at 36% (ES 0.36 [95%CI 0.28–0.43], p < 0.01). AF was associated with significantly lower odds of favourable 90-day functional outcomes post IVT (Odds Ratio [OR] 0.512 [95%CI 0.376–0.696], p < 0.001), but not post EVT (OR 0.826 [95%CI 0.651–1.049], p = 0.117). Our comprehensive meta-analysis highlights the varying prevalence of AF among different reperfusion therapies and its differential impact on patient outcomes. The highest pooled prevalence of AF was observed in EVT patients, followed by BT and IVT patients. Interestingly, our analysis revealed that AF was significantly associated with poorer clinical outcomes following IVT. Such an association was not observed following EVT.

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Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review

D’Anna,

Abu‐Rumeileh,

Merlino

et al. 2024

JAHA

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There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and “mechanical thrombectomy” or “endovascular treatment” as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta‐analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large‐vessel occlusion in the context of cardiac diseases.

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Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

Cited by 5 publications

References 20 publications

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

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

Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes—A Comprehensive Systematic Review and Meta-Analysis

Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review

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