The Proportion of Preventable Thrombectomy Procedures with Improved Atrial Fibrillation Stroke Prevention

Sur, Nicole B.; Saini, Vasu; Torres, Luis F.; Atchaneeyasakul, Kunakorn; Malik, Amer M.; Yavagal, Dileep R.

doi:10.1016/j.jstrokecerebrovasdis.2021.105599

Cited by 4 publications

(7 citation statements)

References 36 publications

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“…The third point is better elucidated by a recent single-center study performed at one of the largest county hospitals in the United States, where 21.7% patients with LVO undergoing MT had known atrial fibrillation but were not adequately anticoagulated. 20 The frequency is even higher in elderly patients, where ≈1 in 4 LVO cases were not adequately anticoagulated prior to incident LVO. 20…”

Section: Large Vessel Occlusionmentioning

confidence: 99%

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Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

2021

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Purpose of the ReviewTo provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.Recent FindingsRandomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients.SummaryStroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.

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Section: Large Vessel Occlusionmentioning

confidence: 99%

“…20 The frequency is even higher in elderly patients, where ≈1 in 4 LVO cases were not adequately anticoagulated prior to incident LVO. 20…”

Section: Large Vessel Occlusionmentioning

confidence: 99%

Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

2021

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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%

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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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Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review

D’Anna,

Abu‐Rumeileh,

Merlino

et al. 2024

JAHA

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There is limited evidence on the outcomes and safety of mechanical thrombectomy (MT) among patients with acute ischemic stroke (AIS) in the context of cardiac diseases. Our study reviews MT in AIS within the context of cardiac diseases, aiming to identify existing and emerging needs and gaps. PubMed and Scopus were searched until December 31, 2023, using a combination of cardiological diseases and “mechanical thrombectomy” or “endovascular treatment” as keywords. Study design included case reports/series, observational studies, randomized clinical trials, and meta‐analyses/systematic reviews. We identified 943 articles, of which 130 were included in the review. Results were categorized according to the cardiac conditions. MT shows significant benefits in patients with atrial fibrillation (n=139) but lacks data for stroke occurring after percutaneous coronary intervention (n=2) or transcatheter aortic valve implantation (n=5). MT is beneficial in AIS attributable to infective endocarditis (n=34), although functional benefit may be limited. Controversy surrounds the functional outcomes and mortality of patients with AIS with heart failure undergoing MT (n=11). Despite technical challenges, MT appears feasible in aortic dissection cases (n=4), and in patients with left ventricular assist device or total artificial heart (n=10). Data on AIS attributable to congenital heart disease (n=4) primarily focus on pediatric cases requiring technical modifications. Treatment outcomes of MT in patients with cardiac tumors (n=8) vary because of clot consistency differences. After cardiac surgery stroke, MT may improve outcomes with early intervention (n=13). Available data outline the feasibility of MT in patients with AIS attributable to large‐vessel occlusion in the context of cardiac diseases.

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The Proportion of Preventable Thrombectomy Procedures with Improved Atrial Fibrillation Stroke Prevention

Cited by 4 publications

References 36 publications

Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

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

Safety and Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Attributable to Cardiological Diseases: A Scoping Review

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