Management of tandem occlusion stroke with endovascular therapy

2012 ◽  
Vol 32 (5) ◽  
pp. E16 ◽  
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.

EXPRESS: Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial

2021 ◽  
pp. 174749302110350
Author(s):  
Kaori Miwa ◽  
Masatoshi Koga ◽  
Manabu Inoue ◽  
Sohei Yoshimura ◽  
Makoto Sasaki ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Intravenous Thrombolysis ◽  
Clinical Impact ◽  
Cerebral Microbleeds ◽  
National Institutes Of Health ◽  
Efficacy And Safety ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Mixed Distribution ◽  
Stroke Thrombolysis

Background and aim: We determined to investigate the incidence and clinical impact of new cerebral microbleeds (CMBs) after intravenous thrombolysis (IVT) in patients with acute stroke. Methods: The THAWS was a multicenter, randomized trial to study the efficacy and safety of IVT with alteplase in patients with wake-up stroke or unknown onset stroke. Prescheduled T2*-weighted imaging assessed CMBs at 3-time points: baseline, 22–36 hours, and 7–14 days. Outcomes included new CMBs development, modified Rankin Scale [mRS] ≥3 at 90 days, and change in the National Institutes of Health Stroke Scale [NIHSS] score from 24 h to 7 days. Results: Of all 131 patients randomized in the THAWS trial, 113 patients (mean 74.3±12.6 years, 50 female, 62 allocated to IVT) were available for analysis. Overall, 46 (41%) had baseline CMBs (15 strictly lobar CMBs, 14 mixed CMBs, and 17 deep CMBs). New CMBs only emerged in the IVT group (7 patients, 11%) within a median of 28.3 h, and did not additionally increase within a median of 7.35 days. In adjusted models, number of CMBs (relative risk [RR]1.30, 95%confidence interval [CI]: 1.17–1.44), mixed distribution (RR 19.2, 95%CI: 3.94–93.7), and CMBs burden ≥5 (RR 44.9, 95%CI: 5.78–349.8) were associated with new CMBs. New CMBs was associated with an increase in NIHSS score (p=0.023). Treatment with alteplase in patients with baseline ≥5 CMBs resulted in a numerical shift toward worse outcomes on ordinal mRS (median [IQR]; 4 [3–4] vs. 0 [0–3]), compared with those with <5 CMBs (common odds ratio 17.1, 95% CI: 0.76 –382.8). The association of baseline ≥5 CMBs with ordinal mRS score differed according to the treatment group (P interaction=0.042). Conclusion: New CMBs developed within 36 h in 11% of the patients after IVT, and they were significantly associated with mixed-distribution and ≥5 CMBs. New CMBs development might impede neurological improvement. Furthermore, CMBs burden might affect the effect of alteplase.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Abstract 118: Diffusion Lesion Volume Reduction after Recanalization Therapy for Anterior Circulation Stroke with Major Vessel Occlusion: Analysis from the RESCUE-Japan Registry Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Hiroshi Yamagami ◽  
Kazunori Toyoda ◽  
Yuji Matsumaru ◽  
Yukiko Enomoto ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Volume Reduction ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Median Baseline ◽  
Point Reduction ◽  
Major Vessel

Objective: Although Diffusion-weighted imaging (DWI) lesions are commonly irreversible, DWI lesion volume reduction (DVR) is occasionally observed. We investigated clinical significance and predictors of DVR in acute stroke patients with major vessel occlusion receiving recanalization therapy (RT). Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan registry prospectively registered 1,442 stroke patients with major vessel occlusion who were admitted to 84 Japanese stroke centers within 24 hours after onset from July 2010 to June 2011. We retrospectively analyzed all patients with the internal carotid artery or middle cerebral artery (M1 or M2 segments occlusions receiving RT and undergoing MRI both on admission and at 24 hours after onset from the registry. We defined DVR as a 1 or more-point reduction of the DWI-Alberta Stroke Program Early CT Score (ASPECTS), and CT-DWI mismatch (CTDM) as a 2 or more-point lower DWI-ASPECTS than CT-ASPECTS on admission. Reperfusion was defined as TICI grade 2b-3 on catheter angiography or modified Mori grade 3 on MRA immediately after RT. Dramatic recovery (DR) was defined as a 10 or more-point reduction or a total NIHSS score of 0-1 at 24 hours, and favorable outcome (FO) defined as a mRS score 0-2 at 3 months. Results: A total of 390 patients (215 men, 72 years old,) was included. Median baseline NIHSS score was 16 (IQR 10-19) and median baseline DWI-ASPECTS was 8 (6-9). CTDM was seen in 92 patients (28%) on admission. Intravenous thrombolysis and endovascular therapy were performed in 246 patients (63%) and 223 patients (57%), respectively. Reperfusion was obtained in 170 patients (51%). DVR was seen in 51 patients (13%). Eighty-eight patients (23%) obtained DR and 158 patients (41%) achieved FO. On multivariate analyses, DVR was significantly related to DR (OR 3.8, 95%CI 1.5-10) and FO (4.6, 1.8-12). CTDM was an independent predictor of DVR (OR 2.5, 95% CI 1.1-5.8). Conclusions: DVR was significantly related to DR and FO. CTDM is a rough predictor of DVR of which area is considered as a “DWI-bright” ischemic penumbra, and might be a useful marker to identify the adequate candidates for RT in spite of relatively large DWI lesions.

Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome?

2018 ◽  
Vol 11 (5) ◽  
pp. 450-454 ◽  
Author(s):  
Sebastien Soize ◽  
Guillaume Fabre ◽  
Matthias Gawlitza ◽  
Isabelle Serre ◽  
Serge Bakchine ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Mechanical Thrombectomy ◽  
Characteristic Curve ◽  
Optimal Threshold ◽  
Future Research ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Good Outcome ◽  
Optimal Thresholds ◽  
Definition Of

Background and purposeWe aimed to identify the best definition of early neurological improvement (ENI) at 2 and 24 hours after mechanical thrombectomy (MT) and determine its ability to predict a good functional outcome at 3 months.MethodsThis retrospective analysis was based on a prospectively collected registry of patients treated by MT for ischemic stroke from May 2010 to March 2017. We included patients treated with stent-retrievers with National Institute of Health Stroke Scale (NIHSS) score before treatment and at 2 and/or 24 hours after treatment and modified Rankin Score (mRS) at 3 months. Receiver operating characteristic curve analysis was performed to estimate optimal thresholds for ENI at 2 and 24 hours. The relationship between optimal ENI definitions and good outcome at 3 months (mRS 0–2) was assessed by logistic regression.ResultsThe analysis included 246 patients. At 2 hours, the optimal threshold to predict a good outcome at 3 months was improvementin the NIHSS score of >1 point (AUC 0.83,95% CI 0.77 to 0.87), with sensitivity and specificity 78.3% (62.2–85.7%) and 84.6% (77.2–90.3%), respectively, and OR 12.67 (95% CI 4.69 to 31.10, p<0.0001). At 24 hours, the optimal threshold was an improvementin the NIHSS score of >4 points (AUC 0.93, 95% CI 0.89 to 0.96), with sensitivity and specificity 93.8% (87.7–97.5%) and 83.2% (75.7–89.2%), respectively, and OR 391.32 (95% CI 44.43 to 3448.35, p<0.0001).ConclusionsENI 24 hours after thrombectomy appears to be a straightforward surrogate of long-term endpoints and may have value in future research.

Abstract WP53: Safety and Efficacy of Mechanical Thrombectomy in Acute Stroke Patients on New Oral Anticoagulants

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nurose Karim ◽  
Alicia C Castonguay ◽  
Hisham Salahuddin ◽  
Julie Shawver ◽  
Syed Zaidi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Oral Anticoagulants ◽  
National Institutes Of Health ◽  
New Oral Anticoagulants ◽  
Limited Data ◽  
Stroke Patients ◽  
Safety And Efficacy ◽  
Nihss Score ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Symptomatic Intracranial Hemorrhage

Background: Limited data exists on the benefits of mechanical thrombectomy (MT) in acute ischemic stroke patients on new oral anticoagulants (NOAC). The aim of our study is to examine the safety and efficacy of MT in NOAC patients at our center. Methods: A retrospective review of our prospective MT database was performed for this study. Baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) score, revascularization rate, symptomatic intracranial hemorrhage rate (sICH), and 90-day mortality and favorable outcomes were compared in MT patients on NOAC (MT-NOAC) versus those who were not on NOAC (MT). Results: From July 2012 to December 2018, 553 AIS patients underwent treatment with MT, with 36 patients on NOAC (6.5%). Median age was similar (73 versus 74), with 52.8% and 52.0% (p=0.8) female in the MT-NOAC and MT groups, respectively. Median baseline NIHSS score (17 IQR10-21 versus 17 IQR 12-21, p=0.75) and ASPECTS (9 IQR 8-9, p=0.80) were similar between the groups. Atrial fibrillation was more prevalent in the MT-NOAC group (80.6% versus 37.7%, p=<0.0001). No difference was seen in occlusion site between the group, with M1 occlusions the most common site (44.4% versus 43.3%, p=0.9). Median onset to revascularization times did not differ between the cohorts (146 minutes versus 206, p=0.61). Successful revascularization (mTICI≥2b) was 87.5% and 81.8% in the MT NOAC and MT groups, respectively. Rates of symptomatic intracerebral hemorrhage per ECASS III criteria were similar between the two groups (5.5% versus 4.6%, p=0.68). No difference was seen in 90-day favorable outcomes (mRS 0-2) (48.3% versus 41.1%, p=0.44) or mortality (27.6% versus 27.1%, 0.95). Conclusion: MT in patients on NOAC appears to be safe and efficacious. As our study is limited by sample size, larger prospective studies are needed to understand the safety and efficacy of MT in AIS patients on NOAC.

Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

2019 ◽  
Vol 12 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Jason J Chang ◽  
Konark Malhotra ◽  
Juan Goyanes ◽  
...  
Keyword(s):  
Regression Models ◽  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Posterior Circulation ◽  
National Institutes Of Health ◽  
Special Focus ◽  
Vessel Occlusion ◽  
Logistic Regression Models

IntroductionOne uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).ObjectiveTo evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.MethodsConsecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.ResultsA total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).ConclusionsIVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

Thrombolytic treatment in stroke mimic, inevitable but fortunately safe: An observational study from Iran

2020 ◽  
Author(s):  
Sara Esmaeili ◽  
Motahareh Afrakhteh ◽  
Maryam Bahadori ◽  
Seyedeh Fahimeh Shojaei ◽  
Rezan Ashayeri ◽  
...  
Keyword(s):  
Alcohol Intoxication ◽  
Intravenous Thrombolysis ◽  
Treatment Decision ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
Number Of Patients ◽  
Acute Cerebral Ischemia ◽  
Tissue Plasminogen ◽  
Baseline Characteristics ◽  
Stroke Mimic

Background: A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center’s SM (Firoozgar Hospital) among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes. Methods: We reviewed the medical records of all patients who received IVT between June 2015 and May 2018. The following variables were collected: demographic characteristics, past medical history, onset-to-needle (OTN) time, door-to-needle (DTN) time, National Institutes of Health Stroke Scale (NIHSS) score at admission, brain imaging, and all paraclinic findings. Functional outcome at discharge based on modified Rankin Scale (mRS) was also assessed. Results: 10 out of 165 (6.0%) patients including 8 men and 4 women were finally diagnosed with SM. The median age and NIHSS score at presentation were 60 years and 7, respectively. Final diagnoses were seizure (n = 6), hemiplegic migraine (n = 2), conversion (n = 1), and alcohol intoxication (n = 1). All patients were discharged with a mRS score of 0 and 1 without experiencing any thrombolytic adverse effects. Conclusion: None of the patients with SM experienced any adverse effect of tissue plasminogen activator (tPA) including hemorrhage and all of them reached good mRS score. This shows that tPA is generally safe and the risk of treating patients with SM is very low and making a vital treatment decision may outweigh the risk of neglected cases in a time-sensitive setting.

Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery

2017 ◽  
Vol 51 (4) ◽  
pp. 176-182 ◽  
Author(s):  
Igor Gunka ◽  
Dagmar Krajickova ◽  
Michal Lesko ◽  
Stanislav Jiska ◽  
Jan Raupach ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Time Interval ◽  
Nihss Score ◽  
Carotid Revascularization ◽  
Extracranial Ica

Background: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. Methods: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. Results: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). Conclusion: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

Catch Plus thrombectomy device in acute stroke: initial evaluation

2016 ◽  
Vol 9 (12) ◽  
pp. 1214-1218 ◽  
Author(s):  
Ahmet Peker ◽  
Ethem Murat Arsava ◽  
Mehmet Akif Topçuoğlu ◽  
Anıl Arat
Keyword(s):  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Initial Experience ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Thrombectomy Device ◽  
Baseline Characteristics ◽  
Mean Time

ObjectiveTo report our initial experience with the Catch Plus thrombectomy device (CPD) in patients with acute ischemic stroke (AIS).Materials and methodsWe retrospectively evaluated the procedural variables as well as the clinical and angiographic outcomes of patients with acute occlusion of a major intracranial artery in the anterior circulation who were treated with CPD at our center. Baseline characteristics (gender, age, comorbidities, cardiovascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and vessel occlusion sites) of these patients were recorded. Thrombolysis in Cerebral Infarction (TICI) score, incidence of symptomatic and asymptomatic bleeding, and 90 day modified Rankin Scale (mRS) scores were evaluated as indicators of outcome.Results38 patients with a mean age of 67.5 years were treated with CPD. Mean time from symptom onset to procedure initiation was 226.7 min. Recanalization (TICI 2b–3) was achieved in 27 patients (71.1%). The median NIHSS score on admission was 20. Rates of symptomatic and asymptomatic intracerebral hemorrhage were 7.9% and 13.2%, respectively. The 90 day clinical follow-up data were available for 37 patients. The 90 day mortality rate was 18.9%, and the 90 day clinically acceptable functional outcome (mRS score ≤2) rate was 43.2% (mRS score 0–3, 54.1%). Very distal thrombectomy involving the cortical arteries was performed on four patients without complications.ConclusionsOur initial experience suggests that mechanical thrombectomy with the CPD improves 90 day outcomes of patients with AIS by facilitating effective recanalization.

scholarly journals 726 Outcomes of ischaemic stroke in patients with atrial fibrillation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Teresa Strisciuglio ◽  
Valerio Pergolae ◽  
Giuseppe Ammirati ◽  
Lucio Addeo ◽  
Gaetano Todde ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Neurological Impairment ◽  
Neurological Recovery ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Neurological Improvement ◽  
History Of ◽  
Different Response

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 &lt; 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 &lt; 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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