Prevalence and Distribution of Intracranial Vessel Occlusion on Angiography and Its Association with Functional Outcome in Patients with Atrial Fibrillation Presenting with Ischemic Stroke

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-09-30 DOI:10.1002/ana.27084

Alexander P. Benz, Thomas R. Meinel, Alexander Salerno, Morin Beyeler, Davide Strambo, Johannes Kaesmacher, Alexandros A. Polymeris, Timo Kahles, Mira Katan, Stefan T. Engelter, Emmanuel Carrera, Elisabeth Dirren, Nils Peters, Carlo W. Cereda, Georg Kägi, Susanne Renaud, Susanne Wegener, Manuel Bolognese, Leo H. Bonati, Urs Fischer, Marcel Arnold, Patrik Michel, Ashkan Shoamanesh, Stuart J. Connolly, David J. Seiffge, the Swiss Stroke Registry Investigators

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Abstract

Objectives

To determine the prevalence and distribution of intracranial vessel occlusion identified on computed tomography (CT) or magnet resonance (MR) angiography and to explore its association with functional outcome in patients with atrial fibrillation (AF) and ischemic stroke.

Methods

Multicenter cohort study enrolling consecutive patients with AF with imaging-confirmed ischemic stroke who underwent CT- or MR-angiography on admission (2014–2022). Multivariable regression was used to explore the association between intracranial vessel occlusion and poor functional outcome (modified Rankin Scale score 3–6) at 90 days.

Results

The analysis included 10,164 patients (median age 81.5 years, 47.8% female, median National Institutes of Health Stroke Scale score on admission 6; 14.7% on a vitamin K antagonist [VKA], 27.5% on a direct oral anticoagulant [DOAC], 57.8% not receiving oral anticoagulation). Angiography showed intracranial vessel occlusion in 5,190 patients (51.1%), affecting the anterior cerebral circulation in 87.4%. Overall, 29.2% and 29.4% of patients received thrombolysis and mechanical thrombectomy, respectively. The proportion of patients with poor functional outcome at 90 days was 60.6% and 42.7% in those with and without vessel occlusion, respectively. In multivariable analyses, vessel occlusion was associated with poor functional outcome (adjusted odds ratio [aOR]: 1.95, 95% confidence interval [CI]: 1.71–2.22) with consistent results in subgroups according to oral anticoagulation use (VKA, aOR: 1.98, 95% CI: 1.40–2.80; DOAC, aOR: 2.35, 95% CI: 1.83–3.03; none, aOR: 1.76, 95% CI: 1.49–2.09).

Interpretation

Intracranial vessel occlusion is common in patients with AF with ischemic stroke, mainly affects the anterior circulation and is associated with poor functional outcome. ANN NEUROL 2024;96:1115–1123

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血管造影显示颅内血管闭塞的发生率和分布及其与心房颤动缺血性卒中患者功能预后的关系

研究目的确定计算机断层扫描（CT）或磁共振（MR）血管造影确定的颅内血管闭塞的发生率和分布情况，并探讨其与心房颤动（AF）和缺血性卒中患者功能预后的关系：多中心队列研究：研究对象为入院时接受 CT 或 MR 血管造影检查（2014-2022 年）、影像学确诊为缺血性卒中的连续房颤患者。研究采用多变量回归法探讨颅内血管闭塞与90天后不良功能预后（改良Rankin量表评分3-6分）之间的关系：分析包括 10,164 名患者（中位年龄 81.5 岁，47.8% 为女性，入院时美国国立卫生研究院卒中量表中位评分 6 分；14.7% 正在服用维生素 K 拮抗剂 [VKA]，27.5% 正在服用直接口服抗凝剂 [DOAC]，57.8% 未接受口服抗凝治疗）。血管造影显示，5190 名患者（51.1%）出现颅内血管闭塞，其中 87.4% 影响到大脑前循环。总体而言，分别有 29.2% 和 29.4% 的患者接受了溶栓治疗和机械性血栓切除术。90天后功能预后不良的患者比例在血管闭塞和未闭塞的患者中分别为60.6%和42.7%。在多变量分析中，血管闭塞与功能预后不佳相关（调整后比值比[aOR]：1.95，95% 置信区间[CI]：1.71-2.22），根据口服抗凝药的使用情况（VKA，aOR：1.98，95% CI：1.40-2.80；DOAC，aOR：2.35，95% CI：1.83-3.03；无，aOR：1.76，95% CI：1.49-2.09）在亚组中结果一致：颅内血管闭塞在房颤伴缺血性卒中患者中很常见，主要影响前循环，与功能预后不良有关。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.