心房颤动对急性基底动脉闭塞患者机械取栓术后结局及长期缺血复发的影响。
Effect of atrial fibrillation on outcomes after mechanical thrombectomy and long-term ischemic recurrence in patients with acute basilar artery occlusion.
作者信息
Zhao Chenhao, Luo Weidong, Liu Xing, Luo Jun, Song Jiaxing, Yuan Junjie, Liu Shuai, Huang Jiacheng, Kong Weilin, Hu Jinrong, Yang Jie, Sun Ruidi, Yue Chengsong, Xie Dongjing, Li Linyu, Sang Hongfei, Qiu Zhongming, Li Fengli, Wu Deping, Zi Wenjie, Yang Qingwu
机构信息
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Medicine, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
出版信息
Front Neurol. 2022 Jul 29;13:909677. doi: 10.3389/fneur.2022.909677. eCollection 2022.
INTRODUCTION
According to the literature on anterior circulation, comorbid atrial fibrillation (AF) is not associated with a worse functional outcome, lower reperfusion rates, or higher rates of intracranial hemorrhage after mechanical thrombectomy (MT) compared to intravenous thrombolysis (IVT) or treatment with supportive care. However, data are limited for the effect of comorbid AF on procedural and clinical outcomes of acute basilar artery occlusion (ABAO) after MT. This study aimed to investigate the effect of atrial fibrillation on outcomes after MT and long-term ischemic recurrence in patients with ABAO.
METHODS
We performed a registered study of the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR, which is registered in the Chinese Clinical Trial Registry, http://www.chictr.org.cn; ChiCTR1800014759) from January 2014 to May 2019, which included 647 patients who underwent MT for ABAO, 136 of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.
RESULTS
On multivariate analysis, AF predicted a shorter puncture-to-recanalization time, higher first-pass effect rate, and lower incidence of angioplasty and/or stenting ( < 0.01). AF had no effect on intracranial hemorrhage incidence [adjusted odds ratio (aOR), 1.093; 95% confidence interval (CI), 0.451-2.652], 90-day functional outcomes (adjusted common odds ratio, 0.915; 95% CI, 0.588-1.424), or mortality (aOR, 0.851; 95% CI, 0.491-1.475) after MT. The main findings were robust in the subgroup and 1-year follow-up analyses. Comorbid AF was the remaining predictor of ischemic recurrence (aOR, 4.076; 95% CI, 1.137-14.612).
CONCLUSIONS
The study revealed no significant difference in the safety and efficacy of MT for ABAO regardless of whether patients had comorbid AF. However, a higher proportion of patients with AF experienced ischemic recurrence within 1 year after MT.
引言
根据关于前循环的文献，与静脉溶栓（IVT）或支持性治疗相比，合并心房颤动（AF）与机械取栓术（MT）后功能预后较差、再灌注率较低或颅内出血率较高无关。然而，关于合并AF对MT后急性基底动脉闭塞（ABAO）的手术和临床结局的影响的数据有限。本研究旨在调查心房颤动对ABAO患者MT后结局及长期缺血复发的影响。
方法
我们对2014年1月至2019年5月进行的急性基底动脉闭塞血管内治疗研究（BASILAR，在中国临床试验注册中心注册，http://www.chictr.org.cn；ChiCTR1800014759）进行了一项注册研究，该研究纳入了647例行ABAO的MT患者，其中136例合并AF。报告并比较了前瞻性定义的基线特征、手术结局和临床结局。
结果
多因素分析显示，AF预示着穿刺至再通时间较短、首次通过效应率较高以及血管成形术和/或支架置入率较低（<0.01）。AF对MT后的颅内出血发生率[调整后的优势比（aOR），1.093；95%置信区间（CI），0.451 - 2.652]、90天功能结局（调整后的共同优势比，0.915；95%CI，0.588 - 1.424）或死亡率（aOR，0.851；95%CI，0.491 - 1.475）没有影响。在亚组分析和1年随访分析中，主要发现是可靠的。合并AF是缺血复发的独立预测因素（aOR，4.076；95%CI，1.137 - 14.612）。
结论
该研究表明，无论患者是否合并AF，ABAO的MT安全性和有效性均无显著差异。然而，AF患者在MT后1年内缺血复发的比例较高。
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