Outcomes of endovascular thrombectomy for acute ischemic stroke in patients with and without atrial fibrillation: a comprehensive systematic review and meta-analysis

Abstract

Background and aims The impact of atrial fibrillation (AF) on outcomes of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) has been studied, with no definitive characterization of how AF might influence the technical and clinical outcomes of EVT. We aimed to perform a meta-analysis to assess the effects of AF on the outcomes of EVT for AIS patients.Methods We searched PubMed, Scopus, and WOS till May 2026 for studies comparing outcomes of EVT for AIS among patients with and without AF. Our primary outcome was the rate of a favorable functional outcome (mRS score 0–2) at 90 days. Secondary outcomes included rates of successful reperfusion, 90-day mortality, and symptomatic intracranial hemorrhage. We pooled odds ratio (OR) with 95% confidence interval (CI).Results We included 19 studies comprising 16,094 patients (6,283 with AF versus 9,811 without AF). The odds of 90-day mRS 0–2 was significantly lower among patients with AF (OR = 0.79, 95% CI 0.67–0.95; p = 0.01), with significant heterogeneity among the included studies. Mortality was significantly higher in the AF group (OR = 1.3, 95% CI 1.14–1.63, p < 0.01). A random-effects model was used for all outcomes.Conclusions Current observational evidence suggests that EVT may remain effective and safe in patients with AF. However, the certainty of evidence is very low, and the findings should be interpreted cautiously. Further research is needed to understand the potential pathophysiological mechanisms that could be implicated in these associations.