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

Lasek–Bal, Anetta; Żak, Amadeusz; Binek, Łukasz; Student, Sebasian; Tomalski, Witold; Krzan, Aleksandra; Puz, Przemysław; Uchwat, Urszula

doi:10.20452/pamw.16148

Cited by 13 publications

(30 citation statements)

References 36 publications

(69 reference statements)

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“…An additional 2 studies were identified via expert recommendation. Finally, 10 studies [14][15][16][17][18][19][20][21][22][23] with 6543 patients were determined to satisfy our inclusion criteria with the appropriate report of outcomes of interest (eFigure 1 in Supplement 1).…”

Section: Search and Screening Resultsmentioning

confidence: 99%

“…The size of the included studies ranged from 78 patients to 4169 patients. Eight studies [14][15][16][17][19][20][21]23 included in our analysis were determined to have good quality, while 2 studies 18,22 were determined to have fair quality (eTable in Supplement 1). Patient characteristics, such as age, baseline NIHSS, use of intravenous thrombolytics, and comorbidities, are detailed in the Table.…”

Section: Study Characteristics and Risk Of Biasmentioning

confidence: 99%

“…Successful reperfusion rates (defined as TICI score 2b-3) were reported in 9 studies [14][15][16][17][18][20][21][22][23] including 5577 AIS patients who underwent MT. Successful reperfusion rates were similar between patients with and without AF (OR, 1.11 [95% CI, 0.78-1.58]; P = .57); however, there was significant heterogeneity among studies (I 2 = 56%; P = .02) (Figure 2A).…”

Section: Successful Reperfusionmentioning

confidence: 99%

“…Nine studies [14][15][16][17][18][19][20][21]23 with 5614 patients compared the rates of SICH after MT between patients with and without AF. Rates of SICH were comparable between groups (OR, 1.05 [95% CI, 0.84-1.31]; P = .68), with no heterogeneity observed across studies (I 2 = 0%; P = .75) (Figure 3).…”

Section: Sich and Mortality Ratesmentioning

confidence: 99%

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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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Section: Search and Screening Resultsmentioning

confidence: 99%

Section: Study Characteristics and Risk Of Biasmentioning

confidence: 99%

Section: Successful Reperfusionmentioning

confidence: 99%

Section: Sich and Mortality Ratesmentioning

confidence: 99%

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Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

et al. 2023

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“…Several studies have shown that the incidence of HT may also be increased in patients with a diagnosis of atrial fibrillation (AF) [33,34], whereas data on sICH frequency in this group of patients is contradictory. Some authors have found AF to be associated with sICH occurrence [44], while others have not [45]. Coronary artery disease is another comorbidity that may affect post-MT HT occurrence [33].…”

Section: Haemorrhagic Transformationmentioning

confidence: 99%

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

Tomaszewska-Lampart

Wiącek²,

Bartosik-Psujek³

2022

Neurol Neurochir Pol.

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Introduction. Acute ischaemic stroke (AIS) is caused by significant disturbances in the cerebral bloodflow (CBF) that lead to brain ischaemia and eventually result in irreversible brain tissue damage. The main goal of its treatment is to restore bloodflow to the areas at risk of necrosis. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the mainstay of current therapy, with the latter being widely employed in selected patients with radiologically proven large vessel occlusion (LVO). Despite convincing evidence of its efficacy, up to half of patients undergoing endovascular treatment (EVT) still do not achieve a beneficial functional outcome; this is mainly due to unfavourable brain tissue sequelae. Therefore, factors associated with known adverse brain changes, such as larger infarct size or haemorrhagic and oedematous complications, should be adequately addressed.Objective. To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short-and long-term prognosis.Material and methods. We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria.Results. We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role.Conclusions. The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance.

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Elevated plasma protein carbonylation increases the risk of ischemic cerebrovascular events in patients with atrial fibrillation: association with a prothrombotic state

Nowak,

Zabczyk,

Natorska

et al. 2024

J Thromb Thrombolysis

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Introduction Plasma protein carbonylation that reflects oxidative stress has been demonstrated to be associated with the prothrombotic fibrin clot phenotype. However, the role of protein carbonyls (PC) in predicting ischemic stroke in atrial fibrillation (AF) is largely unknown. This study aimed to investigate whether PC increase the risk of stroke in anticoagulated AF patients during follow-up. Methods In 243 AF patients on anticoagulation (median age 69 years; median CHA2DS2-VASc of 4), we measured plasma PC using the assay by Becatti, along with plasma clot permeability (Ks), clot lysis time (CLT), thrombin generation, and fibrinolytic proteins, including plasminogen activator inhibitor type 1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI). Ischemic stroke, major bleeding, and mortality were recorded during a median follow-up of 53 months. Results Plasma PC levels (median, 3.16 [2.54–3.99] nM/mg protein) at baseline showed positive associations with age (P < 0.001), CHA2DS2-VASc (P = 0.003), and N-terminal B-type natriuretic peptide (P = 0.001), but not with type of AF or comorbidities except for heart failure (P = 0.007). PC levels were correlated with CLT (r = 0.342, P < 0.001), endogenous thrombin potential (r = 0.217, P = 0.001) and weakly with Ks (r = -0.145, P = 0.024), but not with fibrinogen, PAI-1, or TAFI levels. Stroke was recorded in 20 patients (1.9%/year), who had at baseline 36% higher PC levels (P < 0.001). Elevated PC (P = 0.003) at baseline were independently associated with stroke risk. Conclusion Our findings suggest that in patients with AF enhanced protein carbonylation is associated with increased “residual” risk of stroke despite anticoagulation, which is at least in part due to unfavorably altered fibrin clot phenotype. Graphical Abstract

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

Cited by 13 publications

References 36 publications

Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

Elevated plasma protein carbonylation increases the risk of ischemic cerebrovascular events in patients with atrial fibrillation: association with a prothrombotic state

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