Intravenous thrombolysis before mechanical thrombectomy in patients with atrial fibrillation

The introduction into clinical practice of endovascular mechanical thrombectomy (MT) has brought better results in patients with ischemic stroke from large vessel occlusion (LVO) in the anterior circulation in whom therapy is started 4.5–5 hours after symptoms onset.1–3 Controversies exist about the usefulness of intravenous thrombolysis (IVT) before MT in patients with atrial fibrillation (AF). AF is the probable etiology in >25% of ischemic strokes, and >40% of patients with ischemic stroke from LVO in the anterior circulation have a clinical history of AF.4 5 AF is an independent predictor of poor functional outcome and increased mortality after an ischemic stroke. This is partly explained by covariate older age and associated comorbidities; however, AF-associated strokes involve larger infarct volumes.5 Conceptually IVT before MT might increase the risk for intracranial hemorrhage and favor distal migration of thrombi. On the...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Letter Source Type: research