Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study.

Autor:	Jing Hong Loo, Leow, Aloysius S. T., Mingxue Jing, Ching-Hui Sia, Chan, Bernard P. L., Seet, Raymond C. S., Hock-Luen Teoh, Meyer, Lukas, Fiehler, Jens, Papanagiotou, Panagiotis, Kastrup, Andreas, Mpotsaris, Anastasios, Maus, Volker, Yapici, Furkan, Simonato, Davide, Gabrieli, Joseph D., Cester, Giacomo, Bhogal, Pervinder, Spooner, Oliver, Nikola, Christos
Předmět:	ATRIAL fibrillation treatment PREOPERATIVE care ARTERIAL occlusions CONFIDENCE intervals MYOCARDIAL reperfusion ISCHEMIC stroke CEREBRAL infarction THROMBOLYTIC therapy RETROSPECTIVE studies TREATMENT effectiveness COMPARATIVE studies THROMBECTOMY STROKE patients RESEARCH funding ENDOVASCULAR surgery ODDS ratio LONGITUDINAL method
Zdroj:	Journal of NeuroInterventional Surgery; Dec2023, Vol. 15 Issue 12, p1274-1279, 12p
Abstrakt:	Background The role of bridging intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in the treatment of acute ischemic stroke (AIS) remains debatable. Atrial fibrillation (AF) associated strokes may be associated with reduced treatment effect from IVT. This study compares the effect of bridging IVT in AF and non-AF patients. Methods This retrospective cohort study comprised anterior circulation large vessel occlusion (LVO) AIS patients receiving EVT alone or bridging IVT plus EVT within 6 hours of symptom onset. Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes were successful reperfusion defined as expanded Thrombolysis In Cerebral Infarction (eTICI) grading ≥2b flow, symptomatic intracerebral hemorrhage (sICH), and in-hospital mortality. Results We included 705 patients (314 AF and 391 non-AF patients). The mean age was 68.6 years and 53.9% were male. The odds of good functional outcomes with bridging IVT was higher in the non-AF (adjusted odds ratio (aOR) 2.28, 95% CI 1.06 to 4.91, P=0.035) compared with the AF subgroups (aOR 1.89, 95% CI 0.89 to 4.01, P=0.097). However, this did not constitute a significant effect modification by the presence of AF on bridging IVT (interaction aOR 0.12, 95% CI -1.94 to 2.18, P=0.455). The rate of successful reperfusion, sICH, and mortality were similar between bridging IVT and EVT for both AF and non-AF patients. Conclusion The presence of AF did not modify the treatment effect of bridging IVT. Further individual patient data meta-analysis of randomized trials may shed light on the comparative efficacy of bridging IVT in AF versus non-AF LVO strokes. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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