Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke

Objective. To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. Methods. A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort’s median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance “ANOVA” were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. Results. The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD±1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD±1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD±1.78). Significant predictors of mRS score were smoking (t 3.24, P<0.001), age (t 1.98, P<0.049), and NIHSS score (t 9.979, P 0.000). Conclusion. Ischemic strokes have different etiologies that are associated with different levels of impact on the patient’s clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.

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Abstract TMP57: The Influence of Telomere Length on Ischemic Stroke Risk and Phenotype

Stroke ◽

10.1161/str.51.suppl_1.tmp57 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ezgi Yetim ◽

Mehmet A Topcuoglu ◽

Nuket Yurur Kutlay ◽

Ajlan Tukun ◽

Kader K Oguz ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Telomere Length ◽

Significant Relationship ◽

Stroke Risk ◽

Prior History ◽

Lesion Volume ◽

Nihss Score ◽

Stroke Etiology ◽

Age Related

Background: Telomeres are specific nucleotide repeats that play a central role in control of DNA damage related to cell division and aging. The degree of telomere shortening that occurs as part of aging is associated with age-related non-cancer diseases like hypertension, diabetes mellitus and coronary artery disease. Although a number of studies have highlighted that a similar relationship might exist with ischemic stroke, contradictory reports are also present in the literature. In this study we investigated the association between telomere length and ischemic stroke, not only in terms of stroke risk in general, but also from the perspective of stroke etiology and severity. Methods: In a Caucasian cohort, telomere length was determined by Southern blot from peripheral blood leukocytes in 163 consecutive ischemic stroke patients, and 210 controls without any prior history of ischemic stroke. Univariate and multivariate analyses were performed to determine the contribution of telomere length to stroke risk, stroke etiology, admission NIHSS score and DWI lesion volume. Results: The median (interquartile range) telomere length was 7.0 (5.5-9.0) kb in the overall population. Expectedly, telomere length was negatively correlated with aging (r=-0.23; p<0.001). A short telomere length (i.e. lowest quartile; ≤5.5 kb) was significantly associated with ischemic stroke (OR 3.0, 95%CI 1.8-5.1) when adjusted for age, gender and cardiovascular risk factors. This significant relationship persisted for all stroke etiologies, except for other rare causes of stroke. There was no significant relationship between admission lesion volume and telomere length; however, patients with short telomeres presented with more severe strokes (NIHSS score ≥16) when adjusted for age, risk factors, stroke etiology and infarct volume (OR 7.0; 95%CI 1.7-28.7). Conclusion: Almost all etiologic subtypes of ischemic stroke are related to shortened telomere length, irrespective of the age of the subject. Furthermore, presence of short telomeres negatively influences the tolerance of brain to ischemia, thereby causing more severe clinical phenotypes in these patients in the setting of ischemic stroke.

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Correlation between clot density and recanalization success or stroke etiology in acute ischemic stroke patients

Interventional Neuroradiology ◽

10.1177/1591019917694478 ◽

2017 ◽

Vol 23 (3) ◽

pp. 274-278 ◽

Cited By ~ 9

Author(s):

Manoj Jagani ◽

David F Kallmes ◽

Waleed Brinjikji

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Region Of Interest ◽

Hounsfield Unit ◽

Stent Retriever ◽

Large Artery ◽

Stroke Etiology ◽

Significant Difference ◽

The Mean ◽

Axial Slice

Background Predicting recanalization success for patients undergoing endovascular treatment for acute ischemic stroke is of significant interest. Studies have previously correlated the success of recanalization with the density of the clot. We evaluated clot density and its relationship to revascularization success and stroke etiology. Methods We conducted a retrospective review of 118 patients undergoing intra-arterial therapy for acute ischemic stroke. Mean and maximum thrombus density was measured by drawing a circular region of interest on an axial slice of a non-contrast computed tomography scan. T-tests were used to compare clot density to recanalization success or to stroke etiology, namely large artery atherosclerosis and cardioembolism. Recanalization success was compared in four device groups: aspiration, stent retriever, aspiration and stent retriever, and all other. Results There was no significant difference in the mean clot density in patients with successful ( n = 80) versus unsuccessful recanalization ( n = 38, 50.1 ± 7.4 Hounsfield unit (HU) vs. 53 ± 12.7 HU; P = 0.17). Comparing the large artery thromboembolism ( n = 35) to the cardioembolic etiology group ( n = 56), there was no significant difference in mean clot density (51.5 ± 7.7 HU vs. 49.7 ± 8.5 HU; P = 0.31). A subgroup analysis of middle cerebral artery occlusions ( n = 65) showed similar, non-statistically significant differences between groups. There was no difference in the rate of recanalization success in patients with a mean clot density greater than 50 HU or less than 50 HU in each of the four device groups. Conclusions There was no relationship between clot density and revascularization success or stroke etiology in our study. More research is needed to determine if clot density can predict recanalization rates or indicate etiology.

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Abstract NS10: Rapidly Improving Stroke Symptoms - To Treat or Not to Treat

Stroke ◽

10.1161/str.47.suppl_1.ns10 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Sherri H Friedrich ◽

Anne Alexandrov

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Treatment Decision ◽

Large Artery ◽

Stroke Subtype ◽

Stroke Length ◽

Nihss Score ◽

Treatment Decision Making ◽

Acute Changes ◽

Get With The Guidelines

Background: Acute changes in the NIHSS are common in patients with large artery ischemic stroke. Unfortunately, even small improvements in the NIHSS may be viewed as a reason not to treat with intravenous tPA (IVtPA) among emergency practitioners with less alteplase experience. We sought to quantify outcome of patients denied IVtPA due to NIHSS score change, in an effort to improve future treatment decisions by our emergency practitioners. Methods: A retrospective observational study was conducted using a cohort of acute ischemic stroke patients presenting to our community hospital in southern California between January 1, 2010 and December 31, 2013. All patients in the cohort were denied IVtPA treatment due to perceived "rapidly improving symptoms" suggestive of TIA. The cohort was assembled from our Get with the Guidelines database, with all data verified to validate data accuracy. Descriptive data as well as the NIHSS score prompting the decision against IVtPA, both NIHSS and mRS at discharge, and length of stay (LOS) were entered and analyzed using SPSS. Results: 50 patients were identified for IVtPA non-treatment due to an NIHSS change; patients were 60% male and averaged 71.8 + 11.1 years age. Pre-morbid mRS median was 0. NIHSS median at time of reason not to treat was 3.5. While admission and discharge NIHSS were similar, discharge median mRS was significantly worse than premorbid mRS at 2 (p<0.001), with the majority of patients discharging disabled from their stroke. Length of stay averaged 3.4 + 2.5 days and did not differ by age, gender or stroke subtype, but was positively correlated with discharge NIHSS scores (r=.627; p<0.001) which accounted for 39% of the variance. Conclusion: Change in NIHSS score without total disability resolution is a poor predictor of neurologic outcome after stroke. Regularly sharing discharge outcomes of patients according to IVtPA treatment status may play an important role in changing treatment decision making behaviors among reluctant alteplase users.

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Clinical Characteristics and Outcomes of Acute Ischemic Stroke in Patients with Type 2 Diabetes: A Single-Center, Retrospective Study in Southern China

International Journal of Endocrinology ◽

10.1155/2021/5517228 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Minrui Chen ◽

Weiliang Luo ◽

Jiming Li ◽

Kaiyi Cao ◽

Xiaohui Li ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Large Artery ◽

Nihss Score ◽

Type 2 Dm ◽

Significant Difference

Objective. To explore the associations between type 2 diabetes mellitus (DM) and stroke by evaluating the clinical risk factors, characteristics, and outcomes of acute ischemic stroke (AIS) patients with and without type 2 DM. Methods. A total of 1,156 AIS patients (including 410 with type 2 DM (AIS-DM group)) and 746 without type 2 DM (AIS-NDM group)) were included. Patients’ demographics, auxiliary examinations, clinical manifestations, and treatment outcomes were recorded and analyzed. Results. Among the included AIS patients, 35.46% had type 2 DM. The AIS-DM group had less males (59.76% versus 70.64%), less smokers (33.90% versus 41.96%), more patients with hypertension (72.93% versus 63.94%; p = 0.002 ), higher triglyceride levels (42.93% versus 25.08%; p ≤ 0.01 ), and lower total cholesterol (147.06 mg/dl versus 175.31 mg/dl) than the AIS-NDM group. The proportion of patients with large artery atherosclerosis (LAA) in the AIS-DM group was lower (77.56% versus 85.92%; p < 0.05 ) than that in the AIS-NDM group, and the proportion of patients with small arterial occlusions (SAO) in the AIS-DM group was higher (27.07% versus 13.67%; p < 0.05 ) than that in the AIS-NDM group. The mean National Institutes of Health Stroke Scale (NIHSS) score at admission in the AIS-DM group was lower than that in the AIS-NDM group (4.39 versus 5.00; p = 0.008 ), but there was no significant difference in the NIHSS score or the modified Rankin Scale score between the two groups at discharge. A total of 85 AIS patients underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rtPA). The door-to-needle time (DNT) did not differ significantly between the groups (49.39 ± 30.40 min versus 44.25 ± 15.24 min; p = 0.433 ). In addition, there were no significant differences in the baseline NIHSS score, 7-day NIHSS score, and mRS score at discharge between the groups. After intravenous thrombolysis with rtPA, the AIS-NDM group had better recovery (44.30% versus 29.20%; p = 0.017 ) and a higher ratio of good treatment outcome at discharge (65.60% versus 54.20%; p = 0.762 ). Conclusions. Type 2 DM is associated with AIS and its risk factors, such as dyslipidemia and hypertension. Patients in the AIS-DM group had less LAA and smaller arterial occlusions, and DM could exacerbate the short-term clinical outcomes in AIS patients.

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In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

Scientific Reports ◽

10.1038/s41598-019-51277-8 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Fan Yu ◽

Xiaolu Liu ◽

Qiong Yang ◽

Yu Fu ◽

Dongsheng Fan

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Recurrent Events ◽

Early Stage ◽

High Rate ◽

Large Artery ◽

Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

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A Mendelian randomization analysis of the relationship between cardioembolic risk factors and ischemic stroke

Scientific Reports ◽

10.1038/s41598-021-93979-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Danyang Tian ◽

Linjing Zhang ◽

Zhenhuang Zhuang ◽

Tao Huang ◽

Dongsheng Fan

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Mendelian Randomization ◽

P Wave ◽

Cardioembolic Stroke ◽

Large Artery ◽

Weighted Analysis ◽

Inverse Variance ◽

Weighted Median ◽

Genetically Determined

AbstractObservational studies have shown that several risk factors are associated with cardioembolic stroke. However, whether such associations reflect causality remains unknown. We aimed to determine whether established and provisional cardioembolic risk factors are causally associated with cardioembolic stroke. Genetic instruments for atrial fibrillation (AF), myocardial infarction (MI), electrocardiogram (ECG) indices and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were obtained from large genetic consortiums. Summarized data of ischemic stroke and its subtypes were extracted from the MEGASTROKE consortium. Causal estimates were calculated by applying inverse-variance weighted analysis, weighted median analysis, simple median analysis and Mendelian randomization (MR)-Egger regression. Genetically predicted AF was significantly associated with higher odds of ischemic stroke (odds ratio (OR): 1.20, 95% confidence intervals (CI): 1.16–1.24, P = 6.53 × 10–30) and cardioembolic stroke (OR: 1.95, 95% CI: 1.85–2.06, P = 8.81 × 10–125). Suggestive associations were found between genetically determined resting heart rate and higher odds of ischemic stroke (OR: 1.01, 95% CI: 1.00–1.02, P = 0.005), large-artery atherosclerotic stroke (OR: 1.02, 95% CI: 1.00–1.04, P = 0.026) and cardioembolic stroke (OR: 1.02, 95% CI: 1.00–1.04, P = 0.028). There was no causal association of P‐wave terminal force in the precordial lead V1 (PTFVI), P-wave duration (PWD), NT-pro BNP or PR interval with ischemic stroke or any subtype.

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Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Hospital Pediatrics ◽

10.1542/hpeds.2014-0246 ◽

2015 ◽

Vol 5 (9) ◽

pp. 461-473 ◽

Cited By ~ 15

Author(s):

S. V. Kaiser ◽

L.-A. Bakel ◽

M. J. Okumura ◽

A. D. Auerbach ◽

J. Rosenthal ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Prolonged Length

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Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

Medical Sciences Forum ◽

10.3390/iecmd2021-10315 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6

Author(s):

Sintija Strautmane ◽

Kristaps Jurjāns ◽

Estere Zeltiņa ◽

Evija Miglāne ◽

Andrejs Millers

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Reperfusion Therapy ◽

Cardioembolic Stroke ◽

Study Group ◽

Large Artery ◽

Patient Demographics ◽

Stroke Subtypes ◽

Female Predominance ◽

Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.tp416 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joon-tae Kim ◽

Hee-Joon Bae ◽

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Oral Anticoagulant ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Large Artery ◽

Vascular Events ◽

Nihss Score ◽

Composite Events

Introduction: Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far. Objective: This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD. Methods: Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke. Results: Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35). Conclusion: In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.

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