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

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Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study. / Loo, Jing Hong; Leow, Aloysius St; Jing, Mingxue; Sia, Ching-Hui; Chan, Bernard Pl; Seet, Raymond Cs; Teoh, Hock-Luen; 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; Joshi, Abhishek; Lee, Tsong-Hai; Wu, Jiale; Chen, Yimin; Yang, Shuiquan; Sharma, Vijay Kumar; Tan, Benjamin Yq; Yeo, Leonard Ll.

In: J NEUROINTERV SURG, Vol. 15, No. 12, 12.2023, p. 1274-1279.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Loo, JH, Leow, AS, Jing, M, Sia, C-H, Chan, BP, Seet, RC, Teoh, H-L, Meyer, L, Fiehler, J, Papanagiotou, P, Kastrup, A, Mpotsaris, A, Maus, V, Yapici, F, Simonato, D, Gabrieli, JD, Cester, G, Bhogal, P, Spooner, O, Nikola, C, Joshi, A, Lee, T-H, Wu, J, Chen, Y, Yang, S, Sharma, VK, Tan, BY & Yeo, LL 2023, 'Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study', J NEUROINTERV SURG, vol. 15, no. 12, pp. 1274-1279. https://doi.org/10.1136/jnis-2022-019590

APA

Loo, J. H., Leow, A. S., Jing, M., Sia, C-H., Chan, B. P., Seet, R. C., Teoh, H-L., Meyer, L., Fiehler, J., Papanagiotou, P., Kastrup, A., Mpotsaris, A., Maus, V., Yapici, F., Simonato, D., Gabrieli, J. D., Cester, G., Bhogal, P., Spooner, O., ... Yeo, L. L. (2023). Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study. J NEUROINTERV SURG, 15(12), 1274-1279. https://doi.org/10.1136/jnis-2022-019590

Vancouver

Loo JH, Leow AS, Jing M, Sia C-H, Chan BP, Seet RC et al. Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study. J NEUROINTERV SURG. 2023 Dec;15(12):1274-1279. https://doi.org/10.1136/jnis-2022-019590

Bibtex

@article{56a68db7cf224f509fe2dea54bff2e76,
title = "Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study",
abstract = "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.",
author = "Loo, {Jing Hong} and Leow, {Aloysius St} and Mingxue Jing and Ching-Hui Sia and Chan, {Bernard Pl} and Seet, {Raymond Cs} and Hock-Luen Teoh and Lukas Meyer and Jens Fiehler and Panagiotis Papanagiotou and Andreas Kastrup and Anastasios Mpotsaris and Volker Maus and Furkan Yapici and Davide Simonato and Gabrieli, {Joseph D} and Giacomo Cester and Pervinder Bhogal and Oliver Spooner and Christos Nikola and Abhishek Joshi and Tsong-Hai Lee and Jiale Wu and Yimin Chen and Shuiquan Yang and Sharma, {Vijay Kumar} and Tan, {Benjamin Yq} and Yeo, {Leonard Ll}",
note = "{\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2023",
month = dec,
doi = "10.1136/jnis-2022-019590",
language = "English",
volume = "15",
pages = "1274--1279",
journal = "J NEUROINTERV SURG",
issn = "1759-8478",
publisher = "BMJ PUBLISHING GROUP",
number = "12",

}

RIS

TY - JOUR

T1 - Impact of atrial fibrillation on the treatment effect of bridging thrombolysis in ischemic stroke patients undergoing endovascular thrombectomy: a multicenter international cohort study

AU - Loo, Jing Hong

AU - Leow, Aloysius St

AU - Jing, Mingxue

AU - Sia, Ching-Hui

AU - Chan, Bernard Pl

AU - Seet, Raymond Cs

AU - Teoh, Hock-Luen

AU - Meyer, Lukas

AU - Fiehler, Jens

AU - Papanagiotou, Panagiotis

AU - Kastrup, Andreas

AU - Mpotsaris, Anastasios

AU - Maus, Volker

AU - Yapici, Furkan

AU - Simonato, Davide

AU - Gabrieli, Joseph D

AU - Cester, Giacomo

AU - Bhogal, Pervinder

AU - Spooner, Oliver

AU - Nikola, Christos

AU - Joshi, Abhishek

AU - Lee, Tsong-Hai

AU - Wu, Jiale

AU - Chen, Yimin

AU - Yang, Shuiquan

AU - Sharma, Vijay Kumar

AU - Tan, Benjamin Yq

AU - Yeo, Leonard Ll

N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

U2 - 10.1136/jnis-2022-019590

DO - 10.1136/jnis-2022-019590

M3 - SCORING: Journal article

C2 - 36609541

VL - 15

SP - 1274

EP - 1279

JO - J NEUROINTERV SURG

JF - J NEUROINTERV SURG

SN - 1759-8478

IS - 12

ER -