Correspondence Address: A/Prof. Dennis Cordato, Department of Neurology and Neurophysiology, Liverpool Hospital, Elizabeth Street, Liverpool 2170, Sydney, NSW, Australia. E-mail: Dennis.Cordato@health.nsw.gov.au
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Aim: Patients with atrial fibrillation (AF) are over-represented in endovascular thrombectomy (EVT) populations, due to a high prevalence of large vessel occlusions (LVO) and contraindication to intravenous thrombolysis. This study aims to: (1) compare 90-day functional outcomes (modified Rankin Score mRS 0-2) and mortality in AF vs. non-AF patients receiving EVT; (2) compare 90-day functional outcomes and mortality in AF patients on therapeutic vs. non-therapeutic anticoagulation receiving EVT; and (3) identify factors influencing outcomes in AF patients receiving EVT.
Methods: A retrospective analysis of 394 consecutive patients who received EVT for anterior cerebral circulation (ACC) LVO at an Australian comprehensive stroke center. Main outcome measures [90-day dichotomized mRS (0-2 good; 3-6 poor functional outcome) and mortality] were compared between AF and non-AF patients, and between therapeutic and non-therapeutic anticoagulation cohorts.
Results: 171 (49%) EVT patients had AF. Patients with AF were older, had higher NIHSS and lower rates of thrombolysis administration. AF patients showed improved 90-day mRS on multivariate analysis (aOR 1.988 [1.167-3.387]), with similar mortality (aOR 1.454 [0.785-2.696]). There was no difference in 90-day mRS (aOR 1.402 [0.625-3.145]), successful reperfusion rates (aOR 3.761 [0.661-21.410]) or mortality (aOR 1.077 [0.429-2.705]) between AF patients on therapeutic vs. non-therapeutic anticoagulation. In patients with AF, advancing age and higher NIHSS were independent predictors of worse 90-day functional outcome (OR 1.045, P = 0.020; OR 1.086, P = 0.001) and mortality (OR 1.138, P < 0.001; OR 1.107, P = 0.002). On multivariate analysis, thrombolysis administration improved mortality (OR 0.215, P = 0.016) but not functional outcomes.
Conclusion: Patients with AF showed improved 90-day functional outcome, with similar mortality and sICH, after EVT. Therapeutic anticoagulation did not adversely influence EVT outcomes.
Fu J, Cappelen-Smith C, Edwards L, Cheung A, Manning N, Wenderoth J, Parsons M, Cordato D. Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation. Vessel Plus 2021;5:[Accept]. http://dx.doi.org/10.20517/2574-1209.2021.36