Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion

Pillai, Presaad; Bush, Steven; Kusuma, Yohanna; Чурилов, Леонид; Dowling, Richard; Luu, Vu Dang; Davis, Stephen M.; Mitchell, Peter; Yan, Bernard

doi:10.1136/jnis-2023-020512

Cited by 6 publications

(5 citation statements)

References 34 publications

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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.…”

Section: Resultsmentioning

confidence: 99%

“…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. 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.…”

Section: Resultsmentioning

confidence: 99%

“…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. Four studies 8 , 21 , 24 , 25 were large sample size (n>1500).…”

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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“… 11 First pass effect was defined as defined as single‐pass complete or near‐complete reperfusion during EVT for LVO patients. 12 …”

Section: Methodsmentioning

confidence: 99%

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Liu,

Li,

Chen

et al. 2023

Ann Clin Transl Neurol

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ObjectiveRenal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO).MethodsThis study was a post hoc exploratory analysis of the RESCUE‐BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0–2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non‐LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence.ConclusionThis present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT.

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Impact of first pass effect in endovascular treatment of large core stroke: a post-hoc analysis of the ANGEL-ASPECT trial

Huang,

Sun,

Nguyen

et al. 2024

J NeuroIntervent Surg

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BackgroundThe first-pass effect (FPE) is linked to better safety and efficacy prognosis in patients with small- to- moderate sized ischemic infarctions. We evaluated the incidence, prognosis, and predictors of FPE in patients with large core infarctions (LCIs).MethodsWe conducted a post-hoc analysis of data from the Trial of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT). The FPE was defined as a successful recanalization (expanded Thrombolysis in Cerebral Infarction (eTICI) 2 c/3, and eTICI 2b-3 as modified FPE (mFPE)) after one pass. The primary outcome was clinical functional independence, and the secondary outcomes were independent ambulation, assessed by the modified Rankin Scale (mRS) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) defined by the Heidelberg bleeding classification, any intracranial hemorrhage (ICH), and death within 90 days of stroke onset.ResultsOf the 226 patients in the study, FPE and mFPE were achieved in 33 (14.6%) and 82 (36.3%) patients, respectively. Patients with FPE exhibited shorter onset-to-puncture times (adjusted odds ratio [OR] 0.915; 95% confidence interval [CI]: 0.84 to 0.996), and patients with mFPE were older (OR 1.039; 95% CI: 1.005 to 1.075). mFPE was significantly associated with favorable outcomes (modified Rankin score [mRS] 0–2: OR 2.64; 95% CI: 1.37 to 5.07; mRS 0–3: OR 3.31; 95% CI: 1.73 to 6.33). FPE tended to improve outcomes (mRS 0–3: OR 2.24; 95% CI: 0.92 to 4.97; p=0.08). ICH rates (OR 0.60; 95% CI: 0.34 to 1.05; p=0.07) and 90-day deaths (OR 0.57; 95% CI: 0.30 to 1.09; p=0.09) tended to decrease in patients who achieved mFPE but not in patients who achieved FPE.ConclusionsIn the ANGEL-ASPECT trial, patients who achieved mFPE had a higher rate of independent ambulation and functional independence, and the rates of any ICH and 90-day death tended to decrease.

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Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion

Cited by 6 publications

References 34 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

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Impact of first pass effect in endovascular treatment of large core stroke: a post-hoc analysis of the ANGEL-ASPECT trial

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