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Endovascular thrombectomy confers similar outcomes in stroke with, without AF
The effects of endovascular thrombectomy did not significantly differ in patients who had an acute ischemic stroke either with or without atrial fibrillation, according to an analysis published in EuroIntervention.
“The findings of this study do not support withholding endovascular thrombectomy in patients with atrial fibrillation and acute ischemic stroke,” Alis Heshmatollah, MD, PhD candidate and neurology resident at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote.
Researchers analyzed data from 500 patients from the MR CLEAN trial with a proximal intracranial arterial occlusion. Patients were randomly assigned to undergo endovascular thrombectomy plus the usual care or the usual care alone.
The primary outcome of interest was the modified Rankin scale score at 90 days.
AF was observed in 27% of patients (median age, 72 years; 56% men). Patients with AF were more likely to be older (72 years vs. 61 years), had a worse pre-stroke modified Rankin scale score and were less likely to be treated with IV alteplase (77.8% vs. 93.2%) compared with those without AF.
The treatment effect of endovascular thrombectomy was similar to the overall effect in patients without AF (adjusted common OR = 1.9; 95% CI, 1.3-2.7). Patients with AF had a lower treatment effect (adjusted common OR = 1; 95% CI, 0.6-1.9) vs. those without AF (adjusted common OR = 1.88; 95% CI, 1.3-2.7). However, the interaction between AF and the treatment effect was not significant (P for interaction = .09; adjusted P for interaction = .12), according to the researchers.
“This study did not show significant difference in the [endovascular thrombectomy] effect between acute stroke patients with and those without AF,” Heshmatollah and colleagues wrote. “Although the effect ... appeared to be absent in patients with AF, this study could not prove that AF modified the effect of [endovascular thrombectomy]. A more precise estimate in pooled data from the thrombectomy trials is needed.” – by Darlene Dobkowski
Disclosures: The MR CLEAN trial was supported by unrestricted grants from AngioCare BV, Medtronic/Covidien/ev3, MECAC Gmbr/LAMEPRO, Penumbra, Stryker and Top Medical/Concentric. Erasmus University Medical Center reports receiving funds from Bracco Imaging, Servier Cardiovascular and Stryker. Heshmatollah reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.