Kavi Krishna Devulapalli MD,MPH, Presenter: Nothing to Disclose

Nicholas L. Fulton MD, Abstract Co-Author: Nothing to Disclose

Daniel Pierce Hsu MD, Abstract Co-Author: Nothing to Disclose

Little is known regarding the role of chemical and mechanical therapy in treatment of cardioembolic stroke in patients with atrial fibrillation. We analyzed immediate outcomes of patients undergoing treatment of acute ischemic stroke through both chemical and or mechanical endovascular modalities.

A retrospective analysis of a single institution’s prospectively collected stroke database was conducted. Inclusion criteria included treatment modality by endovascular means including intra-arterial (IA) tissue plasminogen activator (tPA) with or without mechanical thrombectomy (MT), combined intravenous and IA tPA (IV/IA) with or without MT, and MT alone. Outcome measures included favorable neurologic outcome (FNO) as defined by a change in NIHSS score of ≥ 8, successful vessel recanalization defined by TIMI scores ≥ 2, symptomatic intracerebral hemorrhage (sICH) and mortality. Outcomes were evaluated between treatment groups using Fisher's Exact Test. Logistic regression analysis was performed assessing predictors of FNO. Study variables included age, gender, history of diabetes, IV tpA, IA tpA and MT.

Of 41 patients, 12 were treated with IA tPA (7 with MT), 21 with IA/IV tPA (15 with MT), 8 with MT only. FNO were observed in 4/5 IA vs 5/7 IA+MT (P=0.639); 5/5 IV/IA vs 10/15 IV/IA+MT (P=0.236); 7/8 MT (P=0.655). Successful vessel recanalization was observed in 3/5 IA vs 6/7 IA+MT (P=0.523); 3/6 IV/IA vs 12/15 IV/IA+MT (P=0.291); 5/8 MT (P=0.672). sICH occurred in 1/5 IA vs 2/7 IA+MT (P=0.614); 1/6 IV/IA vs 6/15 IV/IA+MT (P=0.613); 1/8 MT (P=0.816). Mortality rates were 1/5 IA vs 2/7 IA+MT (P=0.636); 0/6 IV/IA vs 5/15 IV/IA+MT (P=0.262); 1/8 MT (P=0.695). Younger age (OR=1.1, P=0.024) and female gender (OR=16.4, P=0.026) were found to be predictors of FNO. Treatment modality was not found to be a statistically significant predictor of FNO.

No statistically significant differences in neurologic outcomes between treatment modalities were observed. While not statistically significant, rates of sICH and mortality were greater in patients undergoing MT either with or without tPA, suggesting an increased risk of MT in patients with atrial fibrillation.

Stroke outcomes tend to be worse in patients with atrial fibrillation. Safety and efficacy of endovascular treatment of cardioemblic stroke have not been previously evaluated.

Devulapalli, K, Fulton, N, Hsu, D, Endovascular Treatment of Acute Ischemic Stroke in Patients with Atrial Fibrillation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12029026.html