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 7 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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Characteristics and outcomes of atrial fibrillation detected before and after acute ischemic stroke

D’Anna,

Romoli,

Harvey

et al. 2024

J Neurol

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Background Atrial fibrillation (AF) can be known before the stroke (KAF) or be newly detected after stroke (AFDAS). It is unknown whether the outcome of stroke differs between KAF and AFDAS. We performed a propensity-matched analysis to investigate the outcome of patients with AFDAS and their counterparts with KAF. Methods We analysed a consecutive series of patients enrolled into the EIDASAF study, a single centre, retrospective study of ischemic stroke patients with a diagnosis of AF before or after the event who had been admitted to the Hyperacute Stroke Unit of Imperial College Healthcare NHS Trust between 2010 and 2017. Results Overall, our cohort included 959 patients with AF and acute ischemic stroke. After propensity score matching, 547 patients were matched (404 KAF group and 143 AFDAS group). The rates of in hospital death and of haemorrhagic transformation were significantly higher in KAF patients compared to AFDAS patients. Logistic regression analysis did not reveal a statistically significant influence of AF subtypes on the outcome of death. However, in logistic regression analysis KAF was associated with increased probability of haemorrhagic transformation (OR 9.64; CI 1.29–71.68, p = 0.022) after the index event. Conclusion KAF is associated with an increased risk of haemorrhagic transformation but not of death when compared to AFDAS.

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Influence of atrial fibrillation detection time on outcome after endovascular thrombectomy

Cited by 7 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

Characteristics and outcomes of atrial fibrillation detected before and after acute ischemic stroke

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