Atrial fibrillation is associated with lower likelihood of first-pass effect in thrombectomy for medium vessel occlusion acute ischemic strokes.

IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Omnea Elgendy, Michael J Dubinski, Zixin Yi, Sonali Vij, Tarun Thomas, Iris Charcos, Clint Badger, Karan Patel, Mary Penckofer, Joshua Santucci, Ahmad Ballout, Jane Khalife, Jesse M Thon, Hermann C Schumacher, Khalid A Hanafy, Pratit D Patel, Daniel A Tonetti, Hamza A Shaikh, Tudor G Jovin, Manisha Koneru
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引用次数: 0

Abstract

BackgroundFirst-pass effect (FPE) in endovascular thrombectomy (EVT) is strongly associated with clinically favorable outcomes. Atrial fibrillation (AF)-related strokes have been shown to be associated with greater rates of FPE in acute large vessel occlusions (LVOs). In this study, we aimed to assess the association between AF and achieving FPE in medium vessel occlusions (MeVOs).MethodsA prospectively maintained registry of adult ischemic stroke patients at a comprehensive stroke center between October 2019 and October 2023 was retrospectively screened for inclusion. Patients undergoing EVT for a MeVO were included. Univariable and multivariable logistic regressions with 2500 bootstrap iterations for FPE and mFPE was performed using covariables that were clinically and/or statistically significant. Adjusted odds ratios with 95% confidence intervals (CIs) were reported. Regression performance was assessed using area under the curve (AUC) from receiver operating characteristics curve analysis.Results34.4% of patients with MeVO achieved FPE and 58.2% achieved mFPE. In multivariable logistic regression models, AF was independently associated with lower likelihood of FPE, and AF and prior antiplatelet/anticoagulant use were independently associated with lower likelihood of mFPE. Models for FPE and mFPE had AUCs of 0.80 (95% CI [0.75-0.85]) and 0.86 (95% CI [0.78-0.94]), respectively.ConclusionAF was associated with a significantly lower likelihood of FPE and mFPE in EVT of MeVOs. This may suggest a need to prepare for additional passes and rescue intraprocedural strategies for MeVO in patients with AF.

心房颤动与中等血管闭塞急性缺血性中风取栓术中较低的首过效应相关。
血管内血栓切除术(EVT)的首过效应(first -pass effect, FPE)与临床预后密切相关。心房颤动(AF)相关中风已被证明与急性大血管闭塞(LVOs)中FPE的较高发生率相关。在这项研究中,我们旨在评估心房颤动与实现中度血管闭塞(MeVOs)的FPE之间的关系。方法回顾性筛选2019年10月至2023年10月在综合卒中中心前瞻性维持的成人缺血性卒中患者登记册。接受EVT治疗的MeVO患者也包括在内。使用具有临床和/或统计学意义的协变量,对FPE和mFPE进行单变量和多变量logistic回归,并进行2500次自举迭代。报告了95%置信区间(ci)的校正优势比。结果MeVO患者达到FPE的34.4%,达到mFPE的58.2%。在多变量logistic回归模型中,房颤与较低的FPE可能性独立相关,房颤和既往使用抗血小板/抗凝血药物与较低的mFPE可能性独立相关。FPE和mFPE模型的auc分别为0.80 (95% CI[0.75-0.85])和0.86 (95% CI[0.78-0.94])。结论af与MeVOs EVT发生FPE和mFPE的可能性显著降低相关。这可能表明需要为AF患者的MeVO准备额外的通道和抢救术中策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Interventional Neuroradiology
Interventional Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
3.60
自引率
11.80%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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