Endovascular treatment for ischaemic stroke patients with and without atrial fibrillation, and the effects of adjunctive pharmacotherapy: a narrative review.

Alobaida, Muath ORCID: 0000-0003-1257-1428, Lip, Gregory YH, Lane, Deirdre A ORCID: 0000-0002-5604-9378, Sagris, Dimitrios, Hill, Andrew and Harrison, Stephanie L ORCID: 0000-0002-8846-0946 (2023) Endovascular treatment for ischaemic stroke patients with and without atrial fibrillation, and the effects of adjunctive pharmacotherapy: a narrative review. Expert Opin Pharmacother, 24 (3). pp. 377-388.

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Abstract

INTRODUCTION: Endovascular thrombectomy (EVT) is associated with good clinical outcomes in anterior circulation ischaemic stroke. The impact of EVT on clinical outcomes in patients with ischaemic stroke with and without atrial fibrillation, and the effect of adjunctive pharmacological therapies with EVT, remains unclear. AREAS COVERED: The goal of this narrative review aims to provide an overview of studies which have examined: 1) associations between EVT and outcomes for patients following ischaemic stroke, 2) associations between EVT and outcomes for patients following ischaemic stroke with and without atrial fibrillation, including function, reperfusion, haemorrhage and mortality, 3) the effect of adjunctive pharmacological therapies peri- and post-thrombectomy, and 4) integration of prehospital care on endovascular treatment outcomes. EXPERT OPINION: There is little evidence from randomised controlled trials on the effect of atrial fibrillation on stroke outcomes following EVT and the safety and efficacy of atrial fibrillation treatment in the peri-EVT such as tirofiban or Intravenous thrombolysis with Non-vitamin K Antagonist Oral Anticoagulant. The available evidence from observational studies on atrial fibrillation and EVT outcomes is inconsistent, but factors such as procedural EVT devices, the centre volume, clinician experience, stroke recognition, and inclusion criteria of studies have all been associated with poorer clinical outcomes. Enhancing the clinical network among prehospital and hospitals will facilitate direct transfer to EVT centres, reducing stroke onset to EVT time and optimising stroke outcomes.

Item Type:	Article
Uncontrolled Keywords:	atrial fibrillation, clinical outcomes, Endovascular thrombectomy, pharmacological, Stroke
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	23 Dec 2022 11:20
Last Modified:	21 Dec 2023 02:30
DOI:	10.1080/14656566.2022.2161362
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3166778