The effect of atrial fibrillation on the safety and efficacy of mechanical thrombectomy in patients with stroke

Introduction The association between atrial fibrillation (AF) and the outcome of mechanical thrombectomy (MT) in patients with stroke has not been determined so far. Objectives We aimed to evaluate the effect of AF on the efficacy and safety of MT in patients with stroke and to investigate the association between prior anticoagulation and symptomatic intracranial bleeding (ICB). Patient s an d met hods Patients who underwent MT for stroke were enrolled. The effect of AF on the safety and efficacy of MT was assessed. Clinical data of patients were retrospectively collected. Neurologic status was evaluated on day 1 and 2 after stroke using the National Institute of Health Stroke Scale. Functional status was assessed at 10, 30, and 90 days using the modified Rankin Scale. Result s We enrolled 417 patients with stroke (mean age, 70 years), including 108 patients (25.89%) with AF. Patients with AF were older than those without AF (mean [SD] age, 73.77 [8.97] years and 65.70 [18.88] years, respectively; P <0.01). The percentage of patients with poor functional status at 10, 30, and 90 days after stroke was higher among patients with AF than among those without AF. There were no significant differences between groups in the rate of ICB or death. Age, neurologic status, and the Thrombolysis in Cerebral Infarction score had the strongest effect on the functional status. The use of nticoagulant therapy before stroke did not significantly increase the risk of symptomatic ICB after MT, also in patients with an international normalized ratio in the therapeutic range. Conclusions Atrial fibrillation does not affect MT outcomes in patients with acute stroke. Age, the degree of postinterventional reperfusion, and neurologic status in ultra-acute stroke are the strongest predictors of poor functional status.