Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study

Xu Tong, Shijing Li, Wei Liu, Zeguang Ren, Raynald Liu, Baixue Jia, Xuelei Zhang, Xiaochuan Huo, Gang Luo, Gaoting Ma, Anxin Wang, Yilong Wang, Yongjun Wang, Zhongrong Miao, Dapeng Mo, ANGEL-ACT study group, Zhongrong Miao, Liqiang Gui, Cunfeng Song, Ya Peng, Jin Wu, Shijun Zhao, Junfeng Zhao, Zhiming Zhou, Yongli Li, Ping Jing, Lei Yang, Yajie Liu, Qingshi Zhao, Yan Liu, Xiaoxiang Peng, Qingchun Gao, Zaiyu Guo, Wenhuo Chen, Weirong Li, Xiaojiang Cheng, Yun Xu, Yongqiang Zhang, Guilian Zhang, Yijiu Lu, Xinyu Lu, Dengxiang Wang, Yan Wang, Hao Li, Yang Hua, Deqin Geng, Haicheng Yuan, Hongwei Wang, Haihua Yang, Zengwu Wang, Liping Wei, Xuancong Liufu, Xiangqun Shi, Juntao Li, Wenwu Yang, Wenji Jing, Xiang Yong, Leyuan Wang, Chunlei Li, Yibin Cao, Qingfeng Zhu, Peng Zhang, Xiang Luo, Shengli Chen, Wen Wu Peng, Lixin Wang, Xue Wen, Shugui Shi, Wanming Wang, Wang Bo, Pu Yuan, Dong Wang, Haitao Guan, Wenbao Liang, Daliang Ma, Long Chen, Yan Xiao, Xiangdong Xie, Zhonghua Shi, Xiangjun Zeng, Fanfan Su, Ming Ze Chang, Jijun Yin, Hongxia Sun, Chong Li, Yong Bi, Gang Xie, Yuwu Zhao, Chao Wang, Peng Zhang, Xianjun Wang, Dongqun Li, Hui Liang, Zhonglun Chen, Yan Wang, Yuxin Wang, Lin Yin, Hong Kai Qiu, Jun Wei, Yaxuan Sun, Xiaoya Feng, Weihua Wu, Lianbo Gao, Zhibing Ai, Lan Tan, Li Ding, Qilong Liang, Zhimin Wang, Jianwen Yang, Ping Xu, Wei Dong, Quanle Zheng, Zhenyun Zhu, Liyue Zhao, Qingbo Meng, Yuqing Wei, Xianglin Chen, Wei Wang, Dong Sun, Yongxing Yan, Guangxiong Yuan, Yadong Yang, Jianfeng Zhou, Zhi Yang, Zhenzhong Zhang, Ning Guan, Huihong Wang, Xu Tong, Shijing Li, Wei Liu, Zeguang Ren, Raynald Liu, Baixue Jia, Xuelei Zhang, Xiaochuan Huo, Gang Luo, Gaoting Ma, Anxin Wang, Yilong Wang, Yongjun Wang, Zhongrong Miao, Dapeng Mo, ANGEL-ACT study group, Zhongrong Miao, Liqiang Gui, Cunfeng Song, Ya Peng, Jin Wu, Shijun Zhao, Junfeng Zhao, Zhiming Zhou, Yongli Li, Ping Jing, Lei Yang, Yajie Liu, Qingshi Zhao, Yan Liu, Xiaoxiang Peng, Qingchun Gao, Zaiyu Guo, Wenhuo Chen, Weirong Li, Xiaojiang Cheng, Yun Xu, Yongqiang Zhang, Guilian Zhang, Yijiu Lu, Xinyu Lu, Dengxiang Wang, Yan Wang, Hao Li, Yang Hua, Deqin Geng, Haicheng Yuan, Hongwei Wang, Haihua Yang, Zengwu Wang, Liping Wei, Xuancong Liufu, Xiangqun Shi, Juntao Li, Wenwu Yang, Wenji Jing, Xiang Yong, Leyuan Wang, Chunlei Li, Yibin Cao, Qingfeng Zhu, Peng Zhang, Xiang Luo, Shengli Chen, Wen Wu Peng, Lixin Wang, Xue Wen, Shugui Shi, Wanming Wang, Wang Bo, Pu Yuan, Dong Wang, Haitao Guan, Wenbao Liang, Daliang Ma, Long Chen, Yan Xiao, Xiangdong Xie, Zhonghua Shi, Xiangjun Zeng, Fanfan Su, Ming Ze Chang, Jijun Yin, Hongxia Sun, Chong Li, Yong Bi, Gang Xie, Yuwu Zhao, Chao Wang, Peng Zhang, Xianjun Wang, Dongqun Li, Hui Liang, Zhonglun Chen, Yan Wang, Yuxin Wang, Lin Yin, Hong Kai Qiu, Jun Wei, Yaxuan Sun, Xiaoya Feng, Weihua Wu, Lianbo Gao, Zhibing Ai, Lan Tan, Li Ding, Qilong Liang, Zhimin Wang, Jianwen Yang, Ping Xu, Wei Dong, Quanle Zheng, Zhenyun Zhu, Liyue Zhao, Qingbo Meng, Yuqing Wei, Xianglin Chen, Wei Wang, Dong Sun, Yongxing Yan, Guangxiong Yuan, Yadong Yang, Jianfeng Zhou, Zhi Yang, Zhenzhong Zhang, Ning Guan, Huihong Wang

Abstract

Background and objective: The effect of atrial fibrillation (AF) on outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) is controversial. This study aimed to investigate the association of AF with outcomes after EVT in AIS patients.

Methods: Subjects were selected from ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) - a prospective consecutive cohort of AIS patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and then grouped according to having a history of AF or not. After 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale (mRS) score, successful recanalization after final attempt, symptomatic intracranial hemorrhage (ICH) within 24 h, and death within 90 days were compared.

Results: A total of 1755 patients, 550 with AF and 1205 without AF, were included. Among 407 pairs of patients identified after matching, no significant differences were found in the mRS score (median: 3 vs. 3 points; P = 0.29), successful recanalization (87.2 vs. 85.3%; P = 0.42), symptomatic ICH (9. 4 vs. 9.1%; P = 0.86) and death (16.3 vs. 18.4%; P = 0.44) between patients with and without AF.

Conclusion: The findings of this matched-control study show comparable outcomes of EVT in Chinese AIS patients with and without AF, which do not support withholding EVT in patients with both AIS and AF.

Trial registration: NCT03370939 First registration date: 28/09/2017 First posted date: 13/12/2017.

Keywords: Atrial fibrillation; Endovascular treatment; Ischemic stroke; Propensity score matching.

Conflict of interest statement

The authors have no financial conflicts of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. Abbreviations: AF = atrial fibrillation, ANGEL-ACT = Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke

References

    1. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104–132. doi: 10.1016/j.jacc.2019.01.011.
    1. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–1030. doi: 10.1056/NEJMoa1414905.
    1. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–1018. doi: 10.1056/NEJMoa1414792.
    1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Nijeholt GJ L à, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. doi: 10.1056/NEJMoa1411587.
    1. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–2306. doi: 10.1056/NEJMoa1503780.
    1. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–2295. doi: 10.1056/NEJMoa1415061.
    1. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378:11–21. doi: 10.1056/NEJMoa1706442.
    1. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–718. doi: 10.1056/NEJMoa1713973.
    1. Lin S, Wu B, Hao ZL, Kong FY, Tao WD, Wang DR, He S, Liu M. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study. Cerebrovasc Dis. 2011;31(5):419–426. doi: 10.1159/000323221.
    1. Kimura K, Minematsu K, Yamaguchi T. Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005;76(5):679–683. doi: 10.1136/jnnp.2004.048827.
    1. Henninger N, Goddeau RP, Jr, Karmarkar A, Helenius J, McManus DD. Atrial fibrillation is associated with a worse 90-day outcome than other Cardioembolic stroke subtypes. Stroke. 2016;47(6):1486–1492. doi: 10.1161/STROKEAHA.116.012865.
    1. Steger C, Pratter A, Martinek-Bregel M, Avanzini M, Valentin A, Slany J, Stöllberger C. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian stroke registry. Eur Heart J. 2004;25(19):1734–1740. doi: 10.1016/j.ehj.2004.06.030.
    1. Yue R, Li D, Yu J, Li S, Ma Y, Huang S, Zeng Z, Zeng R, Sun X. Atrial Fibrillation is Associated With Poor Outcomes in Thrombolyzed Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016;95:e3054. doi: 10.1097/MD.0000000000003054.
    1. Hu Y, Ji C. Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis. BMC Neurol. 2021;21(1):66. doi: 10.1186/s12883-021-02095-x.
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 update to the 2018 guidelines for the early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–e418. doi: 10.1161/STR.0000000000000211.
    1. Heshmatollah A, Fransen P, Berkhemer OA, Beumer D, van der Lugt A, Majoie C, Oostenbrugge RJ, van Zwam WH, Koudstaal PJ, Roos Y, Dippel D. Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis. EuroIntervention. 2017;13(8):996–1002. doi: 10.4244/EIJ-D-16-00905.
    1. Smaal JA, de Ridder IR, Heshmatollah A, van Zwam WH, Dippel D, Majoie CB, Brown S, Goyal M, Campbell B, Muir KW, Demchuck AM, Davalos A, Jovin TG, Mitchell PJ, White P, Saver JL, Hill MD, Roos YB, van der Lugt A, van Oostenbrugge RJ. Effect of atrial fibrillation on endovascular thrombectomy for acute ischemic stroke. A meta-analysis of individual patient data from six randomised trials: results from the HERMES collaboration. Eur Stroke J. 2020;5(3):245–251. doi: 10.1177/2396987320923447.
    1. Huang K, Zha M, Gao J, Du J, Liu R, Liu X. Increased intracranial hemorrhage of mechanical thrombectomy in acute ischemic stroke patients with atrial fibrillation. J Thromb Thrombolysis. 2021;51(2):536–544. doi: 10.1007/s11239-020-02269-3.
    1. Munir MB, Alqahtani F, Beltagy A, Tarabishy A, Alkhouli M. Comparative outcomes of mechanical Thrombectomy for acute ischemic stroke in patients with and without atrial fibrillation. J Vasc Interv Radiol. 2017;28(11):1604–1605. doi: 10.1016/j.jvir.2017.06.024.
    1. Akbik F, Alawieh A, Cawley CM, Howard BM, Tong FC, Nahab F, et al. Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke. J Neurointerv Surg. 2021;13(10):883–8. 10.1136/neurintsurg-2020-016720.
    1. Lin CJ, Luo CB, Chien C, Chang FC, Lin CJ, Lee IH, Hsu LC, Chung CP, Liu HY, Chi NF, How CK, Wang SJ, Guo WY, Lin YY. Better endovascular mechanical thrombectomy outcome in atrial fibrillation patients with acute ischemic stroke: a single-center experience. J Chin Med Assoc. 2020;83(8):756–760. doi: 10.1097/JCMA.0000000000000377.
    1. Jia B, Ren Z, Mokin M, Burgin WS, Bauer CT, Fiehler J, Mo D, Ma N, Gao F, Huo X, Luo G, Wang A, Pan Y, Song L, Sun X, Zhang X, Gui L, Song C, Peng Y, Wu J, Zhao S, Zhao J, Zhou Z, Li Y, Jing P, Yang L, Liu Y, Zhao Q, Liu Y, Peng X, Gao Q, Guo Z, Chen W, Li W, Cheng X, Xu Y, Zhang Y, Zhang G, Lu Y, Lu X, Wang D, Wang Y, Li H, Ling L, Peng G, Zhang J, Zhang K, Li S, Qi Z, Xu H, Tong X, Ma G, Liu R, Guo X, Deng Y, Leng X, Leung TW, Liebeskind DS, Wang Y, Wang Y, Miao Z. Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry. Stroke. 2021;52:STROKEAHA120031869. doi: 10.1161/STROKEAHA.120.031869.
    1. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, Marks MP, Prabhakaran S, Kallmes DF, Fitzsimmons BF, Mocco J, Wardlaw JM, Barnwell SL, Jovin TG, Linfante I, Siddiqui AH, Alexander MJ, Hirsch JA, Wintermark M, Albers G, Woo HH, Heck DV, Lev M, Aviv R, Hacke W, Warach S, Broderick J, Derdeyn CP, Furlan A, Nogueira RG, Yavagal DR, Goyal M, Demchuk AM, Bendszus M, Liebeskind DS, Cerebral Angiographic Revascularization Grading (CARG) Collaborators. STIR Revascularization working group. STIR Thrombolysis in Cerebral Infarction (TICI) Task Force Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650–2663. doi: 10.1161/STROKEAHA.113.001972.
    1. von Kummer R, Broderick JP, Campbell BC, et al. The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke. 2015;46(10):2981–2986. doi: 10.1161/STROKEAHA.115.010049.
    1. Tong X, Wang Y, Fiehler J, Bauer CT, Jia B, Zhang X, Huo X, Luo G, Wang A, Pan Y, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Ren Z, Miao Z. Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke: A Matched-Control Study. Stroke. 2021;52:STROKEAHA120031599. doi: 10.1161/STROKEAHA.120.031599.
    1. Widimsky P. Acute ischaemic stroke in atrial fibrillation: worse outcomes unrelated to treatment methods. EuroIntervention. 2017;13(8):905–906. doi: 10.4244/EIJV13I8A134.
    1. Tan BY, Kong WY, Ngiam JN, Teoh HL, Sharma VK, Yeo LL. The role of topographic collaterals in predicting functional outcome after thrombolysis in anterior circulation ischemic stroke. J Neuroimaging. 2017;27(2):217–220. doi: 10.1111/jon.12387.
    1. Sun B, Shi Z, Pu J, Yang S, Wang H, Yang D, Hao Y, Lin M, Ke W, Liu W, Guo F, Bai Y, Zhang S, Li Z, Li S, Zuo M, Xu G, Zi W, Liu X. Effects of mechanical thrombectomy for acute stroke patients with etiology of large artery atherosclerosis. J Neurol Sci. 2019;396:178–183. doi: 10.1016/j.jns.2018.10.017.
    1. Guglielmi V, LeCouffe NE, Zinkstok SM, Compagne K, Eker R, Treurniet KM, Tolhuisen ML, van der Worp HB, Jansen I, van Oostenbrugge RJ, Marquering HA, Dippel D, Emmer BJ, Majoie C, Roos Y, Coutinho JM. Collateral circulation and outcome in atherosclerotic versus Cardioembolic cerebral large vessel occlusion. Stroke. 2019;50(12):3360–3368. doi: 10.1161/STROKEAHA.119.026299.
    1. Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, Wang Y, Zou X, Leung TW, Cai Y, Bai Q, Wu Y, Wang C, Pan X, Luo B, Wong KS. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese intracranial atherosclerosis (CICAS) study. Stroke. 2014;45(3):663–669. doi: 10.1161/STROKEAHA.113.003508.
    1. Yeo L, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why does mechanical Thrombectomy in large vessel occlusion sometimes fail? : A review of the literature. Clin Neuroradiol. 2019;29(3):401–414. doi: 10.1007/s00062-019-00777-1.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner