【論文摘要】Impact of Transcatheter Thrombectomy versus Intravenous Thrombolysis on Short-term Survival and Neurological Outcomes in Atrial Fibrillation Related Acute Ischemic Stroke

Yu-Chen Wang ； Pao-Sheng Yen ； Yi-Tzone Shiao ； Kuan-Cheng Chang

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 221-223

https://doi.org/10.6907/SCJ.201909/SP_1(2).0186

摘要

Background/Synopsis: Trancatheter thrombectomy (TT) was shown to improve the clinical and neurological outcomes in patients with acute ischemic stroke (AIS) caused by intra-cranial occlusion. However, whether TT leads to similar benefits in AIS patients with atrial fibrillation (AF) is still unknown. Objectives/Purpose: To investigate the impact of TT on short-term survival rates and neurological outcomes in AIS patients with AF. Methods/Results: This study retrospectively analyzed 167 consecutive AIS patients with AF from 2014 February to 2017 December. Group A consists of 89 patients receiving TT (age 71±11 years, men 49%), and Group B includes 78 subjects who received intravenous thrombolytic therapy (rTPA) without TT (age 75±11 years, men 54%). We compared the in-hospital and 3 months mortality rates and neurological outcomes between these 2 groups. The demographic data including CHA2DS2VASc score were similar in these 2 groups. Patients receiving TT had higher baseline NIHSS at emergency room (ER) comparing with those receiving rTPA (17.98±6.48 vs. 15.64±6.83, p=0.03). Both TT or rTPA alone significantly improved the neurological outcome (NIHSS). In addition, there was no statistical difference in the NIHSS improvement between patients receiving TT and rTPA alone (Table 1). The in-hospital and 3 months mortality rates were similar between these 2 groups, and there was also no statistical difference between patients receiving TT and rTPA alone in the composite 3 months mortality and symptomatic intracranial hemorrhage rates (Table 2). The logistic regression analysis after adjusting age, gender, CHA2DS2VASc score, the initial NIHSS score at ER, and the NIHSS 24 hours after admission showed TT is not associated with statistical difference of 3 months mortality comparing with rTPA alone. Furthermore, each 1 score increment of the initial NIHSS scale at ER and 24 hours after admission independently predicted 17% (Odds ratio 1.17, 95% CI 1.06-1.29, p＜0.001) and 34% (Odds ratio 1.34, 95% CI 1.16-1.55, p＜0.001) increase of mortality rate respectively (Table 3) Conclusion: In AIS patients with AF, there was no statistically significant difference of short term neurological improvement or mortality rate between patients receiving TT and rTPA alone. The initial NIHSS at ER or 24 hours after admission is an independent factor to predict the 3 months mortality rate in these patients. Since the efficacy of TT in neurological improvement is promising, it should be performed in AIS patients with AF who are not eligible for traditional thrombolytic therapy.