Prevention of Recurrence after Mechanical Thrombectomy for Cardiogenic Embolism Induced by Nonvalvular Atrial Fibrillation: A Report of Three Cases and Literature Review

doi:10.3969/j.issn.1673-5765.2025.01.015

Abstract

Abstract: Ischemic strokes secondary to nonvalvular atrial fibrillation account for 20%-30% of all acute ischemic strokes, and these strokes often have high-load thrombosis, larger cerebrovascular blockages, and poor collateral compensation. Therefore, compared with other types of ischemic strokes, they are characterized by more severe symptoms, worse prognosis, and higher mortality. Patients with such strokes, even if successful revascularization is achieved through thrombectomy, have a high risk of recurrence in the short term after surgery. This article takes three stroke patients with nonvalvular atrial fibrillation as examples to describe the process of stroke recurrence and re-thrombectomy after mechanical thrombectomy. By combining with relevant literature, it analyzes the characteristics of cardiogenic embolism caused by nonvalvular atrial fibrillation and summarizes the preventive measures for the recurrence of patients with such strokes after mechanical thrombectomy.

Key words: Nonvalvular atrial fibrillation; Ischemic stroke; Mechanical thrombectomy; Recurrence; Anticoagulation

摘要： 非瓣膜性心房颤动继发的缺血性卒中占所有急性缺血性卒中的20%～30%，且此类卒中多有高负荷量血栓、较大脑血管堵塞及较差的侧支代偿，因此与其他缺血性卒中相比，具有症状更重、预后更差、死亡率偏高的特点。此类卒中患者，即使成功取栓血管再通，术后短期内也存在较高的复发风险。本文以3例非瓣膜性心房颤动性卒中患者为例，介绍其机械取栓后卒中复发并再次取栓的治疗过程，结合相关文献，分析非瓣膜性心房颤动导致心源性栓塞的特点，总结此类卒中患者机械取栓术后卒中复发的预防措施。

关键词: 非瓣膜性心房颤动; 缺血性卒中; 机械取栓; 复发; 抗凝

CLC Number:

ZHANG Haibing, XIA Weidong, WANG Fengmiao, LI Wenshuai, LI Qingmin, ZHANG Xinfang, ZHANG Quanzhong. Prevention of Recurrence after Mechanical Thrombectomy for Cardiogenic Embolism Induced by Nonvalvular Atrial Fibrillation: A Report of Three Cases and Literature Review[J]. Chinese Journal of Stroke, 2025, 20(1): 119-125.

张海兵, 夏卫东, 王奉淼, 李文帅, 李庆民, 张信芳, 张全忠. 非瓣膜性心房颤动所致心源性栓塞机械取栓术后复发的预防——3例病例报道并文献复习[J]. 中国卒中杂志, 2025, 20(1): 119-125.

References

[1] KELLEY R E，KELLEY B P. Heart-brain relationship in stroke[J/OL]. Biomedicines，2021，9（12）：1835[2024-11-01]. https://doi.org/10.3390/biomedicines9121835.
[2] MA H R，CHE R W，ZHANG Q H，et al. The optimum anticoagulation time after endovascular thrombectomy for atrial fibrillation-related large vessel occlusion stroke：a real-world study[J]. J Neurol，2023，270（4）：2084-2095.
[3] 牛礼东，郁金泰，谭兰. 心房颤动患者的脑卒中预防[J]. 中华行为医学与脑科学杂志，2019，28（1）：28-32.
NIU L D ，YU J T ，TAN L . Stroke prevention in atrial fibrillation[J]. Chin J Behav Med & Brain Sci，2019，28（1）：28-32.
[4] HEALEY J S，AMIT G，FIELD T S. Atrial fibrillation and stroke：how much atrial fibrillation is enough to cause a stroke？[J]. Curr Opin Neurol，2020，33（1）：17-23.
[5] ESSA H，HILL A M，LIP G Y H. Atrial fibrillation and stroke[J]. Card Electrophysiol Clin，2021，13（1）：243-255.
[6] INABA O，YAMAUCHI Y，SEKIGAWA M，et al. Atrial fibrillation type matters：greater infarct volume and worse neurological defects seen in acute cardiogenic cerebral embolism due to persistent or permanent rather than paroxysmal atrial fibrillation[J]. Europace，2018，20（10）：1591-1597.
[7] SEIFFGE D J，WERRING D J，PACIARONI M，et al. Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation[J]. Lancet Neurol，2019，18（1）：117-126.
[8] SMYTHE M A，PARKER D，GARWOOD C L，et al. Timing of initiation of oral anticoagulation after acute ischemic stroke in patients with atrial fibrillation[J]. Pharmacotherapy，2020，40（1）：55-71.
[9] MAC GRORY B，FLOOD S，SCHRAG M，et al. Anticoagulation resumption after stroke from atrial fibrillation[J/OL]. Curr Atheroscler Rep，2019，21（8）：29[2024-11-01]. https://doi.org/10.1007/s11883-019-0790-x.
[10] KOGE J，TANAKA K，YOSHIMOTO T，et al. Early recurrent ischemic events after mechanical thrombectomy：effect of post-treatment intracranial hemorrhage[J]. J Neurol，2021，268（8）：2810-2820.
[11] KOGE J，TANAKA K，YAMAGAMI H，et al. Mechanical thrombectomy for stroke patients anticoagulated with direct oral anticoagulants versus warfarin[J/OL]. J Neurol Sci，2021，427：117545[2024-11-01]. https://doi.org/10.1016/j.jns.2021.117545.
[12] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2024-11-01]. https://doi.org/10.1161/STR.0000000000000211.
[13] STEFFEL J，VERHAMME P，POTPARA T S，et al. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J]. Eur Heart J，2018，39（16）：1330-1393.
[14] OLDGREN J，ÅSBERG S，HIJAZI Z，et al. Early versus delayed non-vitamin K antagonist oral anticoagulant therapy after acute ischemic stroke in atrial fibrillation（timing）：a registry-based randomized controlled noninferiority study[J]. Circulation，2022，146（14）：1056-1066.
[15] HEIJMAN J，HOHNLOSER S H，CAMM A J. Antiarrhythmic drugs for atrial fibrillation：lessons from the past and opportunities for the future[J/OL]. Europace，2021，23（23 Suppl 2）：ii14-ii22[2024-11-01].
https://doi.org/10.1093/europace/euaa426.
[16] CAMM A J，NACCARELLI G V，MITTAL S，et al. The increasing role of rhythm control in patients with atrial fibrillation：JACC state-of-the-art review[J]. J Am Coll Cardiol，2022，79（19）：1932-1948.
[17] ANDRADE J G，TURGEON R D，MACLE L，et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation[J/OL]. Eur Cardiol，2022，17：e10[2024-11-01]. https://doi.org/10.15420/ecr.2021.38.
[18] SANDERCOCK P A G，COUNSELL C，KANE E J. Anticoagulants for acute ischaemic stroke[J/OL]. Cochrane Database Syst Rev，2015（3）：CD000024[2024-11-01]. https://doi.org/10.1002/14651858.CD000024. pub4.