Effect of atrial fibrillation on outcomes after mechanical thrombectomy and long-term ischemic recurrence in patients with acute basilar artery occlusion

Chenhao Zhao; Weidong Luo; Xing Liu; Jun Luo; Jiaxing Song; Junjie Yuan; Shuai Liu; Jiacheng Huang; Weilin Kong; Jinrong Hu; Jie Yang; Ruidi Sun; Chengsong Yue; Dongjing Xie; Linyu Li; Hongfei Sang; Zhongming Qiu; Fengli Li; Deping Wu; Wenjie Zi; Qingwu Yang

doi:10.3389/fneur.2022.909677

Effect of atrial fibrillation on outcomes after mechanical thrombectomy and long-term ischemic recurrence in patients with acute basilar artery occlusion

Front Neurol. 2022 Jul 29:13:909677. doi: 10.3389/fneur.2022.909677. eCollection 2022.

Authors

Chenhao Zhao¹, Weidong Luo¹, Xing Liu², Jun Luo³, Jiaxing Song¹, Junjie Yuan¹, Shuai Liu¹, Jiacheng Huang¹, Weilin Kong¹, Jinrong Hu¹, Jie Yang¹, Ruidi Sun¹, Chengsong Yue¹, Dongjing Xie¹, Linyu Li¹, Hongfei Sang¹, Zhongming Qiu¹, Fengli Li¹, Deping Wu⁴, Wenjie Zi¹, Qingwu Yang¹

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
² Department of Medicine, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
³ Department of Neurology, The 404th Hospital of Mianyang, Mianyang, China.
⁴ Huaian Medical District of Jingling Hospital, Medical School of Nanjing University, Huaian, China.

Abstract

Introduction: According to the literature on anterior circulation, comorbid atrial fibrillation (AF) is not associated with a worse functional outcome, lower reperfusion rates, or higher rates of intracranial hemorrhage after mechanical thrombectomy (MT) compared to intravenous thrombolysis (IVT) or treatment with supportive care. However, data are limited for the effect of comorbid AF on procedural and clinical outcomes of acute basilar artery occlusion (ABAO) after MT. This study aimed to investigate the effect of atrial fibrillation on outcomes after MT and long-term ischemic recurrence in patients with ABAO.

Methods: We performed a registered study of the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR, which is registered in the Chinese Clinical Trial Registry, http://www.chictr.org.cn; ChiCTR1800014759) from January 2014 to May 2019, which included 647 patients who underwent MT for ABAO, 136 of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.

Results: On multivariate analysis, AF predicted a shorter puncture-to-recanalization time, higher first-pass effect rate, and lower incidence of angioplasty and/or stenting (p < 0.01). AF had no effect on intracranial hemorrhage incidence [adjusted odds ratio (aOR), 1.093; 95% confidence interval (CI), 0.451-2.652], 90-day functional outcomes (adjusted common odds ratio, 0.915; 95% CI, 0.588-1.424), or mortality (aOR, 0.851; 95% CI, 0.491-1.475) after MT. The main findings were robust in the subgroup and 1-year follow-up analyses. Comorbid AF was the remaining predictor of ischemic recurrence (aOR, 4.076; 95% CI, 1.137-14.612).

Conclusions: The study revealed no significant difference in the safety and efficacy of MT for ABAO regardless of whether patients had comorbid AF. However, a higher proportion of patients with AF experienced ischemic recurrence within 1 year after MT.

Keywords: acute basilar artery occlusion; atrial fibrillation; ischemic recurrence; mechanical thrombectomy; recurrence.