Incidence of Atrial Fibrillation in Large Vessel Occlusion and Large Embolic Stroke of Undetermined Source

Abstract

Introduction: Large vessel occlusion (LVO) stroke is a common presentation of acute ischemic stroke and is often unknown or cryptogenic in etiology. There is a strong association between atrial fibrillation (AF) and cryptogenic LVO stroke, making it a unique stroke subgroup. Therefore, we propose that any LVO stroke meeting the criteria for an embolic stroke of an undetermined source (ESUS) be classified as large ESUS (LESUS). The purpose of this retrospective cohort study was to report the etiology of anterior LVO strokes that underwent endovascular thrombectomy.Methods: This was a single-center retrospective cohort study characterizing the etiology of acute anterior circulation LVO strokes that received emergent endovascular thrombectomy from 2011 to 2018. Patients with LESUS designation at hospital discharge were changed to cardioembolic etiology if AF was discovered during the two-year follow-up period.Results: Overall, 155 (45%) of 307 patients in the study were found to have AF. New onset AF was discovered in 12 (23%) of 53 LESUS patients after hospitalization. Furthermore, eight (35%) of 23 LESUS patients who received extended cardiac monitoring were found to have AF. Conclusion:Nearly half the patients with LVO stroke who received endovascular thrombectomy were found to have AF. With the use of extended cardiac monitoring devices after hospitalization, AF is frequently discovered in patients with LESUS and may change the secondary stroke prevention strategy.

Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes—A Comprehensive Systematic Review and Meta-Analysis

“…AF patients often receive oral anticoagulant therapy [ 45 , 98 ] which can influence clotting markers [ 99 , 100 ] and contraindicate IVT due to bleeding risks [ 17 ]. EVT is recommended for large vessel occlusion (LVO) strokes [ 17 ], which often have a cardioembolic source, frequently AF, explaining the higher AF prevalence in patients receiving EVT [ 27 , 101 ]. This implies that AF suspicion is heightened in EVT-treated patients with unknown stroke aetiology, necessitating adequate cardiac monitoring [ 101 ].…”

“…EVT is recommended for large vessel occlusion (LVO) strokes [17], which often have a cardioembolic source, frequently AF, explaining the higher AF prevalence in patients receiving EVT [27,101]. This implies that AF suspicion is heightened in EVT-treated patients with unknown stroke aetiology, necessitating adequate cardiac monitoring [101].…”