Skip to main content
SpringerLink
Log in

Clinical features and efficacy of reperfusion therapy in minor ischemic stroke patients with atrial fibrillation

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

The efficacy of reperfusion therapy (RT) using intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy for minor ischemic stroke (MIS) has not yet been established. The present study aimed to elucidate the clinical features of MIS patients with atrial fibrillation (AF) and examine whether they could be potential candidates for RT. Data of MIS patients, defined as those with a score ≤ 5 on the National Institute of Health Stroke Scale, were extracted from patients admitted to our hospital between 2006 and 2018, and clinical characteristics were compared between the AF and non-AF groups. Thereafter, the impact of RT on outcomes in the AF- group was evaluated using the modified Rankin scale (mRS) score 3 months after onset and compared to that of standard medical therapy (SMT) using propensity score matching (PSM). Of 10,483 stroke patients, 3003 were shortlisted, and 457 AF patients and 2546 non-AF patients were finally selected. Patients in the AF group had more RT (13.3% vs. 5.7%, p < 0.001) than those in the non-AF group. Using PSM, 53 patients each were extracted from the AF-RT and AF-SMT groups. The frequencies of mRS = 0 or 1 for the AF-RT and AF-SMT groups were 69.8% and 64.2% (p = 0.536), respectively, with a significant difference in mRS = 0 (56.5% vs. 34.0%, p = 0.019). The present study found that MIS patients with AF underwent more RT than those without AF and that RT compared favorably with SMT for them; further study is warranted to examine whether these patients could be good candidates for RT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Google Scholar 

  2. Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329

    CAS  PubMed  Google Scholar 

  3. Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282:2003–2011

    CAS  PubMed  Google Scholar 

  4. Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387:1723–1731

    PubMed  Google Scholar 

  5. Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21

    PubMed  Google Scholar 

  6. Albers GW, Marks MP, Kemp S et al (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378:708–718

    PubMed  PubMed Central  Google Scholar 

  7. Powers WJ, Rabinstein AA, Teri Ackerson T et al (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke. a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:e46–e110

    PubMed  Google Scholar 

  8. Reeves M, Khoury J, Alwell K et al (2013) Distribution of National Institutes of Health stroke scale in the Cincinnati/Northern Kentucky Stroke Study. Stroke 44:3211–3213

    PubMed  PubMed Central  Google Scholar 

  9. Khatri P, Conaway MR, Johnston KC et al (2012) Acute Stroke Accurate Prediction Study (ASAP) Investigators. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke 43:560–562

    PubMed  Google Scholar 

  10. Yeo LLL, Ho R, Paliwal P et al (2014) Intravenously administered tissue plasminogen activator useful in milder strokes? A meta-analysis. J Stroke Cerebrovasc Dis 23:2156–2162

    PubMed  Google Scholar 

  11. Steger C, Pratter A, Martinek-Bregel M et al (2004) Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J 25:1734–1740

    PubMed  Google Scholar 

  12. Park HK, Kim BJ, Han MK et al (2017) One-year outcomes after minor stroke or high-risk transient ischemic attack: Korean Multicenter Stroke Registry Analysis. Stroke 48:2991–2998

    PubMed  Google Scholar 

  13. Yamaguchi T, Mori E, Minematsu K et al (2006) Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 37:1810–1815

    CAS  PubMed  Google Scholar 

  14. Minematsu K, Toyoda K, Hirano T et al (2013) Guidelines for the intravenous application of recombinant tissue-type plasminogen activator (alteplase), the second edition, October 2012: a guideline from the Japan Stroke Society. J Stroke Cerebrovasc Dis 22:571–600

  15. Zaidat OO, Yoo AJ, Khatri P et al (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663

    PubMed  PubMed Central  Google Scholar 

  16. Smith EE, Fonarow GC, Reeves MJ et al (2011) Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke. Stroke 42:3110–3115

    CAS  PubMed  Google Scholar 

  17. Chen W, Pan Y, Zhao X et al (2017) Intravenous thrombolysis in Chinese patients with different subtype of mild stroke: thrombolysis in patients with mild stroke. Sci Rep 23:2299. https://doi.org/10.1038/s41598-017-02579-2

    Article  CAS  Google Scholar 

  18. Alkhouli M, Alqahtani F, Aljohani S et al (2018) Burden of atrial fibrillation-associated ischemic stroke in the United States. JACC Clin Electrophysiol 4:618–625

    PubMed  Google Scholar 

  19. Wu L, Wang A, Wang X et al (2015) Factors for short-term outcomes in patients with a minor stroke: results from China National Stroke Registry. BMC Neurol 15:253. https://doi.org/10.1186/s12883-015-0505-z

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan

    Eiichi Nomura, Makoto Takemaru, Takahiro Himeno & Ryuhei Kono

  2. Department of Cerebrovascular Research, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan

    Tomoko Fukushima

  3. Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan

    Shinzo Ota

Authors
  1. Eiichi Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Takemaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takahiro Himeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryuhei Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoko Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinzo Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiichi Nomura.

Ethics declarations

Conflicts of interest:

All the authors declared that they have no conflict of interest.

Ethics approval: The study protocol was approved by our institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nomura, E., Takemaru, M., Himeno, T. et al. Clinical features and efficacy of reperfusion therapy in minor ischemic stroke patients with atrial fibrillation. J Thromb Thrombolysis 50, 608–613 (2020). https://doi.org/10.1007/s11239-020-02057-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02057-z

Keywords

Search

Navigation