Efficacy and safety of mechanical thrombectomy for cardioembolic stroke due to atrial fibrillation: a comparison with intravenous thrombolysis alone / 国际脑血管病杂志

ABSTRACT

Objective To investigate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke (CES) due to atrial fibrillation.Methods Patients with CES admitted to Nanjing First Hospital from January 2015 to September 2017 were enrolled retrospectively.They were divided into the thrombectomy group and the intravenous thrombolysis alone group.The baseline data,the National Institutes of Health Stroke Scale (NIHSS) score at 24 h after treatment,rates of good outcome (defined as the modified Rankin Scale score 0-2) at 90 d after onset,hemorrhagic transformation and death between the two groups were compared.Multivariate logistic regression analysis was used to determine the independent factors for the outcomes in patients with CES.Results A total of 117 patients with CES were enrolket,inchding 65 (55.6％) in the thrombectomy group and 52 (44.4％) in the intravenous thrombolysis alone group.Sixty-two patients (53.0％) had good outcome and 55 (47.0％) had poor outcome.The proportion of patients whose NIHSS score decreased ＞ 4 within 24 h after treatment (58.4％ vs.26.9％;x2 =6.254,P =0.007),rates of good recanalization (78.5％ vs.57.7％;x2 =5.850,P =0.016),and good outcome at 90 d (63.1％vs.40.4％;x2 =5.972,P=0.015) in the thrombectomy group were significantly higher than those in the intravenous thrombolysis alone group,while there were no significant differences in the incidences of hemorrhagic transformation,symptomatic intracerebral hemorrhage and gastrointestinal bleeding,as well as mortality at 90 d.Multivariate logistic regression analysis showed that good recanalization (odds ratio [OR] 0.371,95％ confidence interval [CI]0.157-0.876;P =0.024) and thrombectomy (OR 0.398,95％ CI 0.179-0.883;P =0.024) were the independent factors for good outcome,while diabetes (OR 6.572,95％ CI 1.684-25.641;P =0.007) was the independent factor for poor outcome.Conclusion The efficacy of mechanical thrombectomy for patients with CES due to atrial fibrillation is superior to intravenous thrombolysis alone,and it dose not increase the mortality and complications.Good recanalization and mechanical thrombectomy are the independent factors for good outcome,while diabetes is an independent factor for poor outcome in patients with CES due to atrial fibrillation.