Atrial Fibrillation and Intra-arterial Thrombolysis
Background: Atrial fibrillation (AF) is associated with increased stroke severity and mortality. Intra-arterial thrombolysis may be of particular benefit for these patients. Methods: Review of 90 consecutive intra-arterial thrombolysis cases (mean age 69 years, range 25–94; 53% female) performed at UCLA from July 1992 to June 2000. Clinical, radiologic, and angiographic variables were analyzed in relation to AF. Results: AF (56% paroxysmal, 44% chronic) was identified in 53% of all cases. Only 54% of AF was present on admission, with delayed onset in 17% (median 3 days), and no observed in-hospital AF in 29% despite a history of AF. AF was new-onset in 23% of cases. At time of admission, only 30% of known AF patients were receiving antithrombotic treatment for stroke prevention per ACCP guidelines. Anticoagulation was subtherapeutic at presentation in all 11 chronically anticoagulated patients. Time to presentation was shorter for AF patients, 50 minutes vs 67 minutes, p<.03. The recanalization rate (TIMI ≥ 2) in AF patients was 67% (vs 69% in non-AF patients, p=.81). Hemorrhage rates trended higher in AF (46% vs 31%, p=.15), including parenchymal hematomas (38% vs 21%, p=.10) and symptomatic hemorrhages (25% vs 10%, p=.06). Deficit severity at presentation in patients with AF was median NIHSS 16 (vs 15 in non-AF patients, p=.29). Deficit severity improved at day 7 in AF patients to median NIHSS 12 (vs 6 in non-AF patients, p=.32). Functional outcomes at day 7 were similar between groups, with percent dead or disabled (mRS > 2) 60% in AF patients and 52% in non-AF patients, p=.44. AF was associated with a trend toward elevated in-hospital mortality (19% vs 7%, p=.11). Among AF patients, AF was classified as etiologic of stroke in 79% and not etiologic in 21% (SPAF III classification algorithm). No cases of recurrent symptomatic ischemia occurred during hospitalization. Conclusions: In this series, intra-arterial therapy among patients with AF achieved recanalization in 67%, with symptomatic hemorrhagic transformation in 25%, and good functional outcome in 40%. Intra-arterial thrombolysis is a promising treatment for patients with ischemic stroke and atrial fibrillation.