Poor collateral flow with severe hypoperfusion explains worse outcome in acute stroke patients with atrial fibrillation

Abstract

Background: Atrial Fibrillation (AF) is associated with poorer functional outcomes in acute stroke patients. It has been hypothesized that this is due to poor collateral recruitment. Aims: This study aimed to investigate the relationship between AF and collaterals with outcome in thrombectomy patients. Methods: This retrospective cohort study identified 1036 acute ischemic patients from the INternational Stroke Perfusion Imaging REgistry. The cohort was divided into two groups: 432 with AF and 604 without AF. Patients were stratified by collateral grades as good, moderate, and poor. Within each collateral grade, the prediction of AF vs. No AF for good outcome (3-month modified Rankin Scale of 0-2) was determined. Then, within each collateral grade, perfusion was compared between those with and AF and without AF. Results: AF was negatively associated with good outcome in patients with poor collaterals (26.7% vs. 51.2% for AF vs. No AF, odds ratio=0.32 [95% CI 0.22, 0.50], p<0.001), but not in patients with good (50.9% vs 58.1% for AF vs. No AF, odds ratio=0.75 [0.46, 1.23], p=0.249) or moderate collaterals (43.6% vs 50.9% for AF vs. No AF, odds ratio=0.75 [0.47, 1.18], p=0.214). AF was associated with severe hypoperfusion only in patients with poor collateral flow (54.0 vs. 35.5 ml for AF vs. No AF, p<0.001). Conclusions: AF-related stroke is associated with more severe hypoperfusion and worse outcome in those with poor collaterals.

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

“…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.…”

“…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.…”

“…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).…”

“…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.…”

Diagnosis and Management of Atrial Fibrillation in Acute Ischemic Stroke in the Setting of Reperfusion Therapy: Insights and Strategies for Optimized Care

“…Oral anticoagulants also reduce the risk of recurrent stroke in AF patients, which is a substantial source of morbidity and mortality in the setting of AF [105]. Furthermore, there is increasing awareness that poorer collateral perfusion is a predictor that mediates suboptimal clinical outcomes in AIS patients with AF [106][107][108]. A retrospective study revealed that AF was significantly more likely to be present in AIS patients with poor collateral status compared to those with good collateral status [107].…”