A comparative study between direct mechanical thrombectomy and bridging therapy in patients with atrial fibrillation associated anterior circulation large vessel occlusion stroke

Abstract

From January 1, 2015 to December 31, 2021, 94 patients who were diagnosed with atrial fibrillation (AF) associated anterior circulation large vessel occlusion stroke and underwent mechanical thrombectomy in the First Affiliated Hospital of Dalian Medical University were retrospectively collected, including 52 patients in the direct mechanical thrombectomy (dMT) group and 42 patients in the bridging therapy (BT) group. All patients received stent thrombectomy, and the BT group received intravenous thrombolytic therapy with alteplase within 4.5 hours.There were no significant differences in 7 d National Institute of Health Stroke Scale (NIHSS) score[12.0 (5.2, 42.0) vs 10.0 (6.0, 25.8)], incidence of hemorrhage transformation [44.2%(23/52) vs 45.2%(19/42)], symptomatic intracranial hemorrhage[11.5%(6/52) vs 11.9%(5/42)],90 d mortality[34.6% (18/52) vs 38.1% (16/42)]between the two groups(all P>0.05). The rate of 90 d good prognosis in dMT and BT groups was 36.5% (19/52) and 35.7% (15/42), respectively, and the difference was not statistically significant(OR=1.45, 95%CI: 0.39-3.37, P=0.805). The number of stent passes[2(1,3) vs 1(1,2)] and the vessel recanalization time [(81±41)min vs (57±29)min] in the BT subgroup of middle cerebral artery (MCA) occlusion were longer than those in the dMT group (both P<0.05).Therefore, direct thrombectomy has similar efficacy and safety as bridging therapy in the treatment of AF related anterior circulation large vessel occlusive stroke, which is worthy of further research and verification.