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E-011 Safety and efficacy of combined mechanical and pharmacological intervention in acute stroke patients with atrial fibrillation

Objective We report on the use of combined mechanical and pharmacological intra-arterial interventions in patients with atrial fibrillation in acute stroke settings. Background Cardioembolic source is a major cause of ischemic stroke. However, there is limited experience regarding the use of combined mechanical and chemical intra-arterial therapy in acute stroke patients with atrial fibrillation. Design and methods Retrospective chart review was performed on 45 patients with atrial fibrillation who underwent interventional acute stroke treatment from January 2006 to October 2009. The study included 29 men and 16 women, with a mean age of 72 years. The mean National Institutes of Health Stroke Scale was 17 at presentation. The primary outcome measures included for analysis following the intervention were intracranial hemorrhage (ICH), mortality and recanalization rates as well as modified Ranking Score (mRS). Results The mean time from onset of symptoms to beginning of the angiographic procedure was within 3–6 h. 20 patients received 0.9 mg/kg intravenous tissue plasminogen activator (tPA) for 40 min as a bridging therapy prior to any endovascular management. Large vessel occlusions were noted in more than 73% of the patients (n=33) Thirty patients received intra-arterial tPA and a mechanical device was used in 16 patients during endovascular intervention. Mechanical thrombectomy devices utilized were MERCI and Penumbra in 12 and four patients, respectively. Rate of postprocedure symptomatic ICH was 15% (n=7). Nine patients died during the hospital stay (20%). Partial to complete recanalization (TIMI 2 or 3) was achieved in 25 patients (55%). mRS ≤3 was achieved in 23 patients (51%) at the time of discharge. Conclusions Combined mechanical and pharmacological therapies during acute stroke interventions can be safe and effective in achieving revascularization in patients with atrial fibrillation.