Factors Predicting the Use of Endovascular Thrombectomy Following Acute Ischemic Stroke in Adults with Chronic Atrial Fibrillation
Prince Pekyi-Boateng1, Fiifi Duodu1, Maya Gabel2, Agyeman Badu-Prempeh Nana Boakye 3, Gregory Imoukhuede Atafo4, Daniel Kwasi Kyei Pinkrah5, Ama Asantewa Seyiram Dake6, Alvin Papa Otu Tetteh-Quarshie7, Nana Yaa Kyei-Frimpong8, Sher Dhillon9, Derick Boateng 10, Balkiranjit Kaur Dhillon9, Shaheen Sombans11, Yaw Asiedu Adu-Duodu12, FNU Aisha9, Hemamalini Sakthivel13, Kamleshun Ramphul9
1Korle-Bu Teaching Hospital Medical department, 2University of Miami, 3Johns Hopkins Bloomberg School of Public Health, 4St. Dominic Hospital, 5Penbrose Clinic, 6Staywell Healthcare, 7Korle-Bu Teaching Hospital Child health, 837 Military Hospital, 9Independent Researcher, 10University Of Ghana Medical Center, 11Fernandez Foundation, 12Holy Trinity Medical centre, 13One Brooklyn Health System/Interfaith Medical Ctr Program
Objective:

To identify characteristics of individuals with Chronic atrial fibrillation (cAF) who underwent Endovascular thrombectomy (ET).


Background:

ET is often used for treating acute ischemic stroke (AIS), a common complication of cAF. Patient selection for ET is based on the onset and clinical symptoms, functional baseline and imaging characteristics.


Design/Methods:
We queried data from the National Inpatient Sample (NIS) between 2016 and 2020 for cases of AIS with cAF using ICD-10 codes. The use of ET during admission was analyzed using multivariable regression analysis.
Results:

Out of 50,475 patients with cAF admitted for AIS, 13.9%  underwent ET. Dyslipidemia (aOR 1.132, p<.001), obesity (aOR 1.218, p<.001), and Hispanic race (aOR 1.313, p<.001, vs. white) had higher odds of requiring ET. Age ≥ 60 (aOR 0.642, p<.001), chronic kidney disease (CKD) (aOR 0.806, p<.001), prior stroke (aOR 0.807, p<.001), diabetes mellitus (aOR 0.749, p<.001), and Black race (vs. white, aOR 0.851Q, p=0.002) showed lower odds. Drug abuse (aOR 0.884, p=0.419), alcohol abuse (aOR 1.178, p=0.078) and smoking (aOR 0.937, p=0.051), as well as cirrhosis (aOR 0.718, p=0.062), hypertension (aOR 1.011, p=0.743), peripheral vascular disease (aOR 0.97, p=0.595), female sex (vs. male, aOR 0.99, p=0.743), long-term anticoagulation (aOR 1.055, p=0.063), and weekend admissions (aOR 0.972, p=0.371), showed no statistical significance.


Conclusions:

Obesity, dyslipidemia, and Hispanic race were associated with higher odds of undergoing ET, while age ≥ 60, CKD, prior stroke, DM, and Black race were less likely to undergo ET, probably due to associated contraindications. Exploring the relationship between these factors could help clinicians predict ET candidacy, impacting treatment options, and prognosis.


10.1212/WNL.0000000000204982