心房颤动卒中患者血管内治疗及急性颈动脉支架置入术后的抗栓治疗与预后
Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation.
作者信息
Weller Johannes M, Dorn Franziska, Meissner Julius N, Stösser Sebastian, Beckonert Niklas M, Nordsiek Julia, Kindler Christine, Riegler Christoph, Keil Fee, Petzold Gabor C, Bode Felix J
机构信息
Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
出版信息
Neurol Res Pract. 2022 Sep 12;4(1):42. doi: 10.1186/s42466-022-00207-7.
BACKGROUND
Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
METHODS
This is a subgroup analysis of the German Stroke Registry-Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days.
RESULTS
Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3-10.5] vs 7 [4-11], p = 0.73, mRS 4 [IQR 3-4] vs. 4 [IQR 3-5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02).
CONCLUSIONS
In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC.
REGISTRATION
CLINICALTRIALS
gov ; Unique identifier: NCT03356392.
背景
口服抗凝治疗（OAC）是房颤（AF）所致缺血性卒中患者二级预防的主要手段。然而，对于接受血管内治疗（ET）和急性颈动脉支架置入术（CAS）的大动脉闭塞性卒中房颤患者，最佳抗栓药物仍不明确。
方法
这是对德国卒中登记-血管内治疗（GSR-ET）的亚组分析，GSR-ET是一个对接受ET的大动脉闭塞性卒中患者的前瞻性多中心队列研究。纳入在ET期间接受AF和CAS治疗的患者。我们分析了基线和围手术期特征、抗栓策略以及90天时的功能结局。
结果
在登记的6635例患者中，共有82例（1.2%，年龄77.9±8.0岁，39%为女性）在ET期间接受AF和颅外CAS治疗。入院时、ET期间、术后及出院时的抗栓药物差异很大且住院期间（21%）和90天时（39%）的总体死亡率很高。在出院患者（n = 65）中，最常见的抗栓方案是双联抗血小板治疗（DAPT，37%）、单药抗血小板治疗+OAC（25%）和DAPT+OAC（20%）。将DAPT与单药或双联抗血小板治疗+OAC进行比较，出院时的临床特征相似（美国国立卫生研究院卒中量表（NIHSS）中位数7.5[四分位间距，3 - 10.5]对7[4 - 11]，p = 0.73；改良Rankin量表（mRS）4[四分位间距3 - 4]对4[四分位间距3 - 5]，p = 0.79），但未接受OAC的患者90天死亡率更高（32%对4%，p = 0.02）。
结论
在接受ET和CAS治疗的房颤患者中，未接受OAC的患者90天死亡率更高。
注册
临床试验
gov；唯一标识符：NCT03356392。
Zotero 插件