Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

Feras Akbik, Ali Alawieh, C. Michael Cawley, Brian M. Howard, Frank C. Tong, Fadi Nahab, Hassan Saad, Laurie Dimisko, Christian Mustroph, Owen B. Samuels, Gustavo Pradilla, Ilko Maier, Nitin Goyal, Robert M. Starke, Ansaar Rai, Kyle M. Fargen, Marios N. Psychogios, Pascal Jabbour, Reade De Leacy, James GilesTravis M. Dumont, Peter Kan, Adam S. Arthur, Roberto Javier Crosa, Benjamin Gory, Alejandro M. Spiotta, Jonathan A. Grossberg

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Atrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT). Objective: To determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT. Methods: We performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared. Results: AF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001). Conclusions: In patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

Original languageEnglish (US)
Article number016720
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2020

Keywords

  • hemorrhage
  • stroke
  • thrombectomy
  • thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke'. Together they form a unique fingerprint.

Cite this