AIMS: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT. METHODS AND RESULTS: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12). CONCLUSIONS: This study did not show significant difference in the EVT effect between acute stroke patients with and those without AF.
RCT Entities:
AIMS: Endovascular thrombectomy (EVT) improves outcome after acute ischaemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study was to determine whether atrial fibrillation (AF) modifies the effect of EVT. METHODS AND RESULTS: MR CLEAN was a randomised clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline. Treatment effect modification by AF was assessed using a multiplicative interaction variable. We included all 500 patients. In total, 135 (27%) had AF. These patients were older, had a worse pre-stroke mRS score and were less often treated with IV alteplase. In patients without AF, the estimated treatment effect was similar to the overall treatment effect (acOR 1.9, 95% CI: 1.3 to 2.7). In patients with AF, the treatment effect appeared lower (acOR 1.0, 95% CI: 0.6 to 1.9). The interaction of treatment effect and AF was not significant (p=0.09, after adjustment p=0.12). CONCLUSIONS: This study did not show significant difference in the EVT effect between acute strokepatients with and those without AF.
Authors: Heinrich P Mattle; Carl Scarrott; Mairsil Claffey; John Thornton; Juan Macho; Christian Riedel; Michael Söderman; Alain Bonafé; Michel Piotin; John Newell; Tommy Andersson Journal: Interv Neuroradiol Date: 2018-12-18 Impact factor: 1.610
Authors: J A Smaal; I R de Ridder; A Heshmatollah; W H van Zwam; Dwj Dippel; C B Majoie; S Brown; M Goyal; Bcv Campbell; K W Muir; A M Demchuck; A Davalos; T G Jovin; P J Mitchell; P White; J L Saver; M D Hill; Y B Roos; A van der Lugt; R J van Oostenbrugge Journal: Eur Stroke J Date: 2020-05-13
Authors: Feras Akbik; Ali Alawieh; Alejandro M Spiotta; Jonathan A Grossberg; C Michael Cawley; Brian M Howard; Frank C Tong; Fadi Nahab; Hassan Saad; Laurie Dimisko; Christian Mustroph; Owen B Samuels; Gustavo Pradilla; Ilko Maier; Nitin Goyal; Robert M Starke; Ansaar Rai; Kyle M Fargen; Marios N Psychogios; Pascal Jabbour; Reade De Leacy; James Giles; Travis M Dumont; Peter Kan; Adam S Arthur; Roberto Javier Crosa; Benjamin Gory Journal: J Neurointerv Surg Date: 2020-12-14 Impact factor: 8.572
Authors: Vaclav Prochazka; Tomas Jonszta; Daniel Czerny; Jan Krajca; Martin Roubec; Jirka Macak; Petr Kovar; Petra Kovarova; Martin Pulcer; Renata Zoubkova; Ivo Lochman; Veronika Svachova; Lubomir Pavliska; Adela Vrtkova; David Kasprak; Jaromir Gumulec; John W Weisel Journal: Med Sci Monit Date: 2018-06-11