726 Outcomes of ischaemic stroke in patients with atrial fibrillation

Abstract Aims Atrial fibrillation (AF) increases the risk of ischaemic strokes (IS) and is associated with a more severe neurological impairment. We sought to investigate whether AF also impacts the neurological recovery and whether patients with AF have a different response to the treatment. Methods and results Data of patients admitted to the Stroke Unit of our institution from January to December 2020 were retrieved from the local database. The stroke severity was calculated by mean of the National Institute of Health Stroke Scale (NIHSS) at hospital admission (NIHSSad), at 24 h (NIHSS24) and at discharge (NIHSSdis). The functional capacity was assessed by the modified Rankin score (mRS). As for the neurological recovery, this was assessed by the delta NIHSS at 24 h (Δ24 = NIHSS24−NIHSSad) and at discharge (Δdis = NIHSSdis−NIHSSad). Out of 545 patients with IS 64 had known history of AF or were admitted with AF. Patients with AF had higher NIHSSad (13.9 ± 7 vs. 8.5 ± 7; P < 0.001) and NIHSS24 (9.6 ± 8 vs. 6.4 ± 7; P = 0.007) than patients without, however the neurological improvement was greater (Δdis −7.4 ± 9 vs. −3.4 ± 6; P = 0.002), indeed the NIHSSdis was similar (4.2 ± 5 vs. 4.2 ± 6; P = 0.98). Patients with AF also had a more impaired mRS before the ischaemic event and at discharge (2.4 ± 1.9 vs. 1.6 ± 1.7, P = 0.02; 1.2 ± 1.2 vs. 0.4 ± 0.9, P < 0.001). Among AF patients with CHADVASC ≥ 3, 34% of them were taking antiplatelet therapy, 31% anticoagulants, and 35% didn’t take any therapy. Of interest, no differences in the NIHSSad nor in the NIHSSdis were found between them and neither in the Δdis. As for the treatment of AF patients, no differences in the neurological recovery were observed between those treated with intravenous thrombolysis and those not treated at all (Δdis 2.8 ± 5 vs. 2.8 ± 8, P = 1), whereas the Δdis was significantly higher in patients treated with mechanical thrombectomy (−11.7 ± 7, P = 0.007). Conclusions Patients with AF experience more severe stroke, however the neurological recovery is greater than in patients without the arrhythmia. The treatment with antiplatelets or anticoagulants before the event does not reduce the severity of the stroke and does not influence the improvement of the NIHSS at discharge. The mechanical thrombectomy is more effective in reducing the neurological impairment.

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HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.101 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Ignatius Ivan ◽

Budi Riyanto Wreksoatmodjo ◽

Octavianus Darmawan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Severe Stroke ◽

History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords: Atrial fibrillation, heart failure, ischemic stroke, myocardial infarction, National Institutes of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

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Management of tandem occlusion stroke with endovascular therapy

Neurosurgical FOCUS ◽

10.3171/2012.1.focus11350 ◽

2012 ◽

Vol 32 (5) ◽

pp. E16 ◽

Cited By ~ 9

Author(s):

Haitham Dababneh ◽

Waldo R. Guerrero ◽

Anna Khanna ◽

Brian L. Hoh ◽

J Mocco

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

National Institutes Of Health ◽

Nihss Score ◽

Neurological Improvement ◽

Point Reduction ◽

Mca Occlusion ◽

Tandem Occlusion ◽

Multimodality Approach ◽

Extracranial Ica

Object Approximately 25% of patients with middle cerebral artery (MCA) occlusion will have a concomitant internal carotid artery (ICA) occlusion, and 50% of patients with an ICA occlusion will have a proximal MCA occlusion. Cervical ICA occlusion with MCA embolic occlusion is associated with a low rate of recanalization and poor outcome after intravenous thrombolysis. The authors report their experience with acute ischemic stroke patients who suffered tandem ICA/MCA (TIM) occlusions and underwent intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial MCA mechanical thrombectomy. Methods In a retrospective analysis of their stroke database (2008–2011), the authors identified 2 patients with TIM occlusion treated with intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy. They examined early neurological improvement defined by a greater than 10-point reduction of National Institutes of Health Stroke Scale (NIHSS) score and an improved modified Rankin Scale (mRS) score at 60 days. Successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2 or 3 was also evaluated. Results In both patients a TICI score of 2b or 3 was achieved, signifying successful recanalization. In addition, both patients had a reduction in the NIHSS score by greater than 10 points and an mRS score of 0 at 60 days. Conclusions Tandem occlusions of the cervical ICA and MCA may be successfully treated using the multimodality approach of intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy.

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Advances in the treatment of acute ischemic stroke: the 2018 American Stroke Association recommendation

Bulletin of Medical Sciences ◽

10.2478/orvtudert-2018-0016 ◽

2018 ◽

Vol 91 (2) ◽

pp. 81-88

Author(s):

Csiba László

Keyword(s):

Mechanical Thrombectomy ◽

Time Windows ◽

Intravenous Thrombolysis ◽

Blood Glucose Measurement ◽

Perfusion Ct ◽

Glucose Measurement ◽

Imaging Studies ◽

Severe Stroke ◽

Clopidogrel Therapy ◽

Field Defect

Abstract The imaging studies should be performed within 20 minutes after arrival and the door-to-needle time should be less than 60 minutes in more than 50 % of the patients. The time-windows and the outcome should be evaluated systematically. If the patient is suitable for intravenous (IV) thrombolysis within 3 hours (based on imaging) only the blood glucose measurement should precede the IV lysis. IV thrombolysis within 3 hours is recommended not only in case of severe stroke, but also in patients with severe isolated symptoms (e.g. aphasia or visual field defect) and in patients with improving paresis. The IV lysis should be considered both in patients on aspirin monotherapy or aspirin+clopidogrel therapy. The criteria for stroke cases between 3 to 4.5 hours became less exclusive: IV intervention can be considered in patients ≥80years, in patients with previous stroke and diabetes and also in patients with INR < 1.7. Mechanical thrombectomy (for interna or media occlusion) can be also considered within 4.5 hours after a non-successful intravenous thrombolysis. Other criteria for mechanical thrombectomy (interna or media occlusion) between 4.5 and 6 hours: NIHSS ≥ 6, ASPECTS score ≥ 6. For patients with interna or media occlusion between 6 and 16 hours, only mechanical thrombectomy could be recommended (by Solitaire or TREVO retriever), if the patient has large penumbra (confirmed by either perfusion CT or MRI and following the criteria of DAWN and DEFUSE-3 studies). Between 16 and 24 hours after stroke, a mechanical thrombectomy can be considered (selected by perfusion CT or MRI), if the patient fulfills DAWN criteria.

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Access to Mechanical Thrombectomy for Ischemic Stroke in the United States

Stroke ◽

10.1161/strokeaha.120.033485 ◽

2021 ◽

Author(s):

Hooman Kamel ◽

Neal S. Parikh ◽

Abhinaba Chatterjee ◽

Luke K. Kim ◽

Jeffrey L. Saver ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

The United States ◽

Sensitivity Analyses ◽

Stroke Severity ◽

Discharge Data ◽

Cerebral Vessel

Background and Purpose: Mechanical thrombectomy helps prevent disability in patients with acute ischemic stroke involving occlusion of a large cerebral vessel. Thrombectomy requires procedural expertise and not all hospitals have the staff to perform this intervention. Few population-wide data exist regarding access to mechanical thrombectomy. Methods: We examined access to thrombectomy for ischemic stroke using discharge data from calendar years 2016 to 2018 from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Facilities were classified as hubs if they performed mechanical thrombectomy, gateways if they transferred patients who ultimately underwent mechanical thrombectomy, and gaps otherwise. We used standard descriptive statistics and unadjusted logistic regression models in our primary analyses. Results: Among 205 681 patients with ischemic stroke, 100 139 (48.7% [95% CI, 48.5%–48.9%]) initially received care at a thrombectomy hub, 72 534 (35.3% [95% CI, 35.1%–35.5%]) at a thrombectomy gateway, and 33 008 (16.0% [95% CI, 15.9%–16.2%]) at a thrombectomy gap. Patients who initially received care at thrombectomy gateways were substantially less likely to ultimately undergo thrombectomy than patients who initially received care at thrombectomy hubs (odds ratio, 0.27 [95% CI, 0.25–0.28]). Rural patients had particularly limited access: 27.7% (95% CI, 26.9%–28.6%) of such patients initially received care at hubs versus 69.5% (95% CI, 69.1%–69.9%) of urban patients. For 93.8% (95% CI, 93.6%–94.0%) of patients with stroke at gateways, their initial facility was capable of delivering intravenous thrombolysis, compared with 76.3% (95% CI, 75.8%–76.7%) of patients at gaps. Our findings were unchanged in models adjusted for demographics and comorbidities and persisted across multiple sensitivity analyses, including analyses adjusting for estimated stroke severity. Conclusions: We found that a substantial proportion of patients with ischemic stroke across the United States lacked access to thrombectomy even after accounting for interhospital transfers. US systems of stroke care require further development to optimize thrombectomy access.

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Abstract T MP104: The Role of Antithrombotics Therapy in Recent Ischaemic Stroke Patients with Atrial Fibrillation: Analysis from VISTA

Stroke ◽

10.1161/str.45.suppl_1.tmp104 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Azmil H Abdul-Rahim ◽

Rachael L Fulton ◽

Frank Benedikt ◽

Turgut Tatlisumak ◽

Maurizio Paciaroni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Recurrent Stroke ◽

Previous History ◽

Neurological Impairment ◽

Antithrombotic Treatment ◽

Risk Of Mortality ◽

Natural Progression ◽

Increased Risk ◽

History Of

Background and Purpose: There is uncertainty on the optimal latency after acute ischaemic stroke at which antithrombotic treatment should commence for atrial fibrillation (AF) patients, in order to prevent recurrent stroke (RS) without provoking symptomatic intracranial haemorrhage (SICH). We sought to describe the risk factors and patterns of RS and SICH in a cohort of patients with AF and recent stroke. Methods: We assessed the association of antihrombotic treatment (i.e. anticoagulants and antiplatelets) with the distribution of the modified Rankin Scale (mRS) at day 90, and the occurrence of RS and SICH. We developed statistical models for the prediction of RS and SICH in the first 90 days after stroke, using univariate and multivariate analysis. Results: Data were available for 1,644 patients. Combined antithrombotic therapy with both anticoagulation and antiplatelet (n=782) was associated with more favourable functional outcome across full scale mRS OR=1.785 (95% CI: 1.316, 2.421; P=0.0002), and significantly lower risk of mortality by day 90, SICH by day 90 and RS by day 90: Mortality day 90 OR=0.344 (95% CI: 0.235, 0.502; P<0.0001), SICH day 90 OR=0.18 (95% CI: 0.086, 0.37; P<0.0001) and RS day 90 OR=0.33 (95% CI: 0.21, 0.53; P<0.0001). Patients with ischaemic stroke who had high baseline glucose had a high risk of both RS and SICH events after stroke. Additionally, patients who had increased neurological impairment, previous history of TIA and received no antithrombotic treatment were at increased risk of RS. The relative risk of RS versus SICH appeared constant over time. Conclusions: It seems justified to initiate anticoagulation immediately the patient attains medical and neurological stability, taking into account the potential of haemorrhagic transformation as part of the natural progression in stroke and the increasing risk of recurrent stroke with time if left untreated. Antiplatelet treatment pending introduction of anticoagulation is reasonable.

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Abstract 179: Ischemic Stroke in Atrial Fibrillation: 30-day Outcomes and Factors Associated with Severity

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.179 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Darae Ko ◽

Jonathan Thigpen ◽

Lori Henault ◽

Emily Quinn ◽

Yorghos Tripodis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Critical Role ◽

Blood Stasis ◽

Functional Independence ◽

Multivariable Logistic Regression Analysis ◽

Stroke Severity ◽

High Morbidity ◽

Severe Stroke ◽

Statin Use

Background and Hypothesis: Ischemic stroke (IS) in atrial fibrillation (AF) is associated with high mortality. Inflammation, endothelial dysfunction, and hypercoagulability, in addition to blood stasis in the left atrium, play a critical role in thrombogenesis in AF. Hyperglycemia and chronic kidney disease (CKD) are potent triggers for inflammation, oxidative stress, and thrombogenesis. Statins have been shown to possess anti-inflammatory, anti-oxidant, and anti-thrombotic properties. Accordingly, we assessed the hypothesis that statin use may modulate stroke severity in AF. Methods: Consecutive IS admissions were identified from 2006-2010. All events were subject to CT or MRI and assessed for functional independence at discharge using modified Rankin scale (mRS). AF was confirmed by ECG at presentation or within the prior 6 months in all cases. Covariates were abstracted from the medical record. To account for confounding by treatment, we used multivariable logistic regression analysis adjusted using inverse probability weighting. Results: We identified 1,030 AF-related IS; mean age was 77, 56% were female, mean CHA 2 DS 2 VASC score was 4.8 designating high baseline stroke risk. IS resulted in severe neurological deficit or death (mRS ≥ 4) for 69%; 21% died within 30-days. Severe stroke was associated with older age, diabetes, dementia, prior ischemic stroke, prior venous thromboembolism, and CKD (Table). Baseline statin use was associated with a 33% reduced risk of sustaining a severe stroke. Conclusion: Strokes in AF are associated with high morbidity and mortality. Clinical markers of thrombophilia, including prior IS, DVT, and PE, were significantly associated with severe strokes. Diabetes and CKD independently increased this risk. Statin use resulted in less severe outcomes. Advancing our basic understanding of these interrelated thrombogenic pathways will inform clinical interventions to reduce these devastating outcomes.

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Treatment of Middle Cerebral Artery Occlusion and Internal Carotid Artery Dissection with Combined Mechanical Thrombectomy and Stenting of the Internal Carotid Artery

The Neuroradiology Journal ◽

10.1177/197140091302600114 ◽

2013 ◽

Vol 26 (1) ◽

pp. 84-88 ◽

Cited By ~ 2

Author(s):

A. Wetter ◽

Mi-Rim Shin ◽

D. Meila ◽

F. Brassel ◽

M. Schlunz-Hendann

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Artery Dissection ◽

Severe Stroke ◽

The Right

We describe a case of combined mechanical thrombectomy of the right middle cerebral artery and stent angioplasty of the right internal carotid artery in a severe stroke caused by arterio-arterial embolism due to a traumatic dissection of the internal carotid artery. The patient was admitted with an NIHSS score of 19 and was discharged from hospital with a score of 2. Three months later neurological examination disclosed no pathological findings. The case demonstrates the crucial role of interventional procedures in the treatment of severe stroke where intravenous thrombolysis has little prospect of success.

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Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19

Stroke ◽

10.1161/strokeaha.120.030574 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2540-2543 ◽

Cited By ~ 33

Author(s):

Simon Escalard ◽

Benjamin Maïer ◽

Hocine Redjem ◽

François Delvoye ◽

Solène Hébert ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Stroke Onset ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Neurological Improvement ◽

Poor Outcomes

Background and Purpose: Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. Methods: All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. Results: We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. Conclusions: Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.

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Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016720 ◽

2020 ◽

pp. neurintsurg-2020-016720

Author(s):

Feras Akbik ◽

Ali Alawieh ◽

C Michael Cawley ◽

Brian M Howard ◽

Frank C Tong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Intracranial Hemorrhage ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Anterior Circulation ◽

Increased Risk ◽

First Pass

BackgroundAtrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).ObjectiveTo determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.MethodsWe performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).ConclusionsIn patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

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Persistent or permanent atrial fibrillation is associated with severe cardioembolic stroke in patients with non-valvular atrial fibrillation

Thrombosis Journal ◽

10.1186/s12959-021-00276-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Joji Hagii ◽

Norifumi Metoki ◽

Shin Saito ◽

Hiroshi Shiroto ◽

Satoko Sasaki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Functional Outcome ◽

Oral Anticoagulants ◽

Japanese Patients ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Stroke Severity ◽

Group 13 ◽

Severe Stroke ◽

The Difference

Abstract Background Little is known about the difference in the severity of cardioembolic (CE) stroke between patients with paroxysmal atrial fibrillation (PAF) and persistent/permanent AF (PerAF). We assessed stroke severity in patients with CE stroke divided by the type of AF. Methods Three hundred and fifty-eight consecutive patients with CE stroke within 48 h of onset and with a modified Rankin Scale (mRS) score ≤ 1 before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between patients with PAF (n = 127) and PerAF (n = 231). Results Patients with PerAF were more likely to take oral anticoagulants (OACs) than those with PAF (37% vs. 13%, P < 0.0001), even though still underuse of OAC in both patients. Regarding stroke severity on admission, patients with PerAF exhibited a tendency toward a higher score on the National Institutes of Health Stroke Scale (NIHSS) compared with patients with PAF (12 [5–20] vs. 9 [4–18]; P = 0.12). Mortality and mRS score at discharge were higher in the PerAF than in the PAF group (13% vs. 4%; P = 0.005, and 3 [1–5] vs. 2 [1–4]; P = 0.01, respectively). Multivariate analyses confirmed that PerAF was a significant determinant of severe stroke (NIHSS score > 8) on admission (odds ratio [OR] to PAF = 1.80; 95% confidence interval [CI] 1.08–2.98; P = 0.02) and of an mRS score ≥ 3 at discharge (OR = 2.07; 95% CI 1.24–3.46; P = 0.006). Patients with PerAF had three times more internal carotid artery occlusion evaluated by magnetic resonance angiography, which indicated a more severe cerebral embolism compared with patients with PAF. Conclusions We found underuse of OAC in high risk AF patients with CE stroke. PerAF is significantly associated with severe stroke on admission and an unfavorable functional outcome at discharge in Japanese patients with CE stroke.

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