Effect of atrial fibrillation on outcomes in patients with anterior circulation occlusion stroke receiving endovascular therapy

Weijuan Wu; Jamir Pitton Rissardo; Thanh N Nguyen; Mohammad Mofatteh; Hongquan Wei; David S Liebeskind; Shuiquan Yang; Wanquan Li; Wanling Pan; Sijie Zhou; Yuzheng Lai; Jianfang Gao; Jian Wang; Ziqi Ouyang; Yuzhen Mai; Heng Meng; Yimin Chen; Xuxing Liao

doi:10.3389/fnagi.2023.1160265

Effect of atrial fibrillation on outcomes in patients with anterior circulation occlusion stroke receiving endovascular therapy

Front Aging Neurosci. 2023 Jun 15:15:1160265. doi: 10.3389/fnagi.2023.1160265. eCollection 2023.

Authors

Weijuan Wu¹, Jamir Pitton Rissardo², Thanh N Nguyen³, Mohammad Mofatteh⁴, Hongquan Wei⁵, David S Liebeskind⁶, Shuiquan Yang¹, Wanquan Li⁷, Wanling Pan⁷, Sijie Zhou⁸, Yuzheng Lai⁹, Jianfang Gao¹⁰, Jian Wang¹⁰, Ziqi Ouyang¹¹, Yuzhen Mai¹², Heng Meng¹³, Yimin Chen^{1

14}, Xuxing Liao^{8

11}

Affiliations

¹ Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, China.
² Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil.
³ Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States.
⁴ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
⁵ Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
⁶ UCLA Stroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.
⁷ Department of Internal Medicine-Cardiovascular, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
⁸ Department of Neurosurgery, First People's Hospital of Foshan, Foshan, Guangdong, China.
⁹ Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, Guangdong, China.
¹⁰ Department of Research and Education, Foshan Sanshui District People's Hospital, Foshan, China.
¹¹ Department of Neurosurgery and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
¹² Department of Neurology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
¹³ Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
¹⁴ Neuro International Collaboration (NIC), Foshan, China.

Abstract

Objective: Atrial fibrillation is one of the major risk factors of ischemic stroke. Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. However, data regarding the impact of AF on the outcome of patients with acute ischemic stroke treated with mechanical thrombectomy are controversial. The aim of our study was to determine whether atrial fibrillation modifies the functional outcome of patients with anterior circulation acute ischemic stroke receiving EVT.

Methods: We reviewed 273 eligible patients receiving EVT from January 2019 to January 2022 from 3 comprehensive Chinese stroke centers, of whom 221 patients were recruited. Demographics, clinical, radiological and treatment characteristics, safety outcomes, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome.

Results: In our cohort, 79 patients (35.74%) were eventually found to have AF. Patients with AF were elder (70.08 ± 11.72 vs. 61.82 ± 13.48 years, p = 0.000) and less likely to be males (54.43 vs. 73.94%, p = 0.03). The significant reperfusion rate (modified thrombolysis in cerebral infarction 2b-3) was 73.42 and 83.80% in patients with and without AF, respectively (p = 0.064). The good functional outcome (90-day modified Rankin scale: 0 to 2) rate was 39.24 and 44.37% in patients with and without AF, respectively (p = 0.460) after adjusting multiple confounding factors. There was no difference in the presence of symptomatic intracerebral hemorrhage between the two groups (10.13 vs. 12.68%, p = 0.573).

Conclusion: Despite their older age, AF patients achieved similar outcomes as non-AF patients with anterior circulation occlusion treated with endovascular therapy.

Keywords: atrial fibrillation; cerebrovascular; endovascular thrombectomy (EVT); occlusion; patient outcome; stroke.

Grants and funding

This study was supported by Foshan Science and Technology Bureau (Grant No. 2220001005022), Medical Science Technology Research Foundation of Guangdong Province (Grant No. 20221027164016611), the Foshan 14th Five-Year Plan Key Discipline Foundation, China, the Guangdong provincial TCM Bureau Key Discipline Foundation, China, and Foshan Competitive Talent Support Project Fund (Brain-Heart Talent Project-Build the Brain-Heart Comorbidity Multi-disciplinary Medical Center). Fund Project of Health Bureau of Foshan City of Guangdong Province in 2023 (Grant No. 20230309).