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Abstract Details

The Proportion of Thrombectomy Cases That Could Be Avoided With Improved Atrial Fibrillation Stroke Prevention
Cerebrovascular Disease and Interventional Neurology
S35 - Stroke Prevention Strategies (1:22 PM-1:33 PM)
003
Despite established efficacy of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), OAC is largely underutilized.
To identify the rate of atrial fibrillation (AF) in patients with ischemic stroke and large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT) and evaluate the treatment patterns of AF prior to the incident stroke. 

This study included 180 consecutive MT cases at a high-volume stroke center from February 2015 to June 2017. A retrospective chart review was conducted to identify patient sociodemographics, presence of AF, use of anticoagulation, stroke severity, CHA2DS2-VASc scores, and functional outcome. 

AF was present in 91 (50.6%) cases. Compared to patients without AF, patients with AF were older (mean 78.8±10.4 years vs. 66.7±14.1 years) and 59.5% were women. Initial NIHSS score was similar between the two groups (17.1±5.5 vs. 15.8±6.6; P=0.17). In the AF group, 52 (29%) patients had a previous diagnosis of AF and of these, 33 (63.4%) patients were not on OAC. Of those on warfarin, 6/7 (85.7%) were subtherapeutic with INR < 2.0. Of those on a direct oral anticoagulant, 3/12 (25%) were non-adherent and received intravenous alteplase. Of the 33 patients with prior diagnosis of AF not on OAC, 3 (9%) had CHA2DS2-VASc score ≤1 and aspirin may have been an alternative. There was no difference in functional outcome between the AF vs. non-AF groups in terms of NIHSS score at 24-36 hours (13.4±8.3 vs. 13.0±9.3 [P=0.73]) and modified Rankin Scale score (4.1±1.7 vs. 3.67±1.8 [P=0.11]) at discharge.

In our study, 39 (21.7%) patients with LVO undergoing MT had known AF and were not adequately treated. Approximately 1 in 5 thrombectomy cases in our study could have been avoided with improved stroke prevention measures. Further research is necessary to understand barriers to OAC in patients with AF. 

Authors/Disclosures
Nicole B. Sur, MD (University of Miami)
PRESENTER
Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
Vasu Saini, MD (Mount Sinai Medical Center) Dr. Saini has nothing to disclose.
Luis F. Torres, MD (Vivian L Smith Department of Neurosurgery) Dr. Torres has nothing to disclose.
Kunakorn Atchaneeyasakul, MD (Jackson Memorial Hospital) No disclosure on file
Amer Malik, MD (University of Miami Miller School of Medicine) Dr. Malik has nothing to disclose.
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine) Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland) Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar & Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS.