TY - JOUR T1 - Intravenous thrombolysis before mechanical thrombectomy in patients with atrial fibrillation JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019749 SP - jnis-2022-019749 AU - Antonio Bozzani AU - Vittorio Arici AU - Franco Ragni AU - Antonio Sterpetti AU - Eloisa Arbustini Y1 - 2022/10/28 UR - http://jnis.bmj.com/content/early/2022/10/27/jnis-2022-019749.abstract N2 - 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.5Conceptually IVT before MT might increase the risk for intracranial hemorrhage and favor distal migration of thrombi. On the other hand, immediate IVT may reduce the time of cerebral ischemia, IVT being a simple initial therapeutic choice while the patient is evaluated as a potential candidate for endovascular MT. Disability despite revascularization is frequent and related with time-dependent irreversible injury to some brain tissue. It is possible that a substantial volume of brain tissue could have been already irreversibly injured in some patients by the time reperfusion occurs. The longer the time of cerebral ischemia the higher the possibility of endothelial damage with consequent reduced nitrogen dioxide (NO2) production and vasoconstriction, and impaired antithrombotic function.1 2A recent article Akbik et al6 analyzed retrospectively the clinical outcomes of 6461 patients who underwent MT for LVO; 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90-day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to … ER -