Background: Acute ischemic strokes in atrial fibrillation (Afib) patients are associated with higher degree of disability, and worse outcomes than in patients with no AF. Mechanical thrombectomy (MT) has been recently assigned a class IA recommendation for the treatment of ischemic stroke in select group of patients. However, single center reports suggested possible worse outcomes of MT in patients with AF due to the larger and more organized/resistant clots.
Methods: We utilized the national database to compare in-hospital outcomes and resource utilization of MT for ischemic stroke in patients with and without AF.
Results: Out of 933,659 patients admitted with ischemic stroke between 2003 - 2014, 4627 patients (0.5%) underwent MT. Out of these patients, 1480 (32%) had concomitant AF while remaining patients were categorized as non-AF cohort. AF patients were older (74 vs. 60 years, p< 0.001) and had significantly higher burden of key co-morbidities as compared to non-AF group (Table-1). After propensity matching, there was no difference in in-hospital mortality following MT in patients with and without AF (20.7% vs. 23.9%, p=0.069). Rates of hemorrhagic stroke conversion, gastrointestinal bleeding, blood transfusion, tracheostomy, gastrostomy, home vs. intermediate care facility discharge, hospital charges and length of stay were also similar in the two groups (Table-1).
Conclusion: In contemporary U.S practice, MT for ischemic stroke in AF patients results in comparable in-hospital morbidity and mortality and cost compared with patients without AF. These data have implications in risk stratification of acute stroke patients who are eligible for MT.