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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Revascularization for acute ischemic stroke is safe for rivaroxaban users
Satoshi Kimura1, Toshiyasu Ogata1, Jiro Fukae1
1Department of Neurology, Fukuoka University, Japan.
Summary
Recombinant tissue plasminogen activator (rt-PA) and endovascular thrombectomy may be safe for acute ischemic stroke patients on the novel oral anticoagulant rivaroxaban. This case study shows no hemorrhagic complications occurred during combined treatment.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- The safety of acute ischemic stroke treatments, including recombinant tissue plasminogen activator (rt-PA) and endovascular therapy, in patients taking novel oral anticoagulants (NOACs) for atrial fibrillation is not well-established.
- Novel oral anticoagulants (NOACs) are increasingly prescribed for stroke prevention in patients with atrial fibrillation.
Observation:
- A case report details an 83-year-old woman with a history of ischemic stroke due to paroxysmal atrial fibrillation, who was on daily rivaroxaban (a NOAC).
- Despite taking her prescribed rivaroxaban dose, the patient experienced a recurrent ischemic stroke, leading to right middle cerebral artery (MCA) occlusion.
- The patient received both intravenous rt-PA and subsequent endovascular thrombectomy.
Findings:
- No hemorrhagic complications were observed during or after the combined rt-PA and endovascular thrombectomy treatments.
- While recanalization of the MCA inferior branch was achieved, the patient still experienced a left frontal lobe infarct.
- The patient's neurological symptoms did not show significant improvement despite the interventions.
Implications:
- This case suggests that thrombolysis and endovascular thrombectomy may be safe treatment options for acute ischemic stroke in patients concurrently using rivaroxaban.
- Further research is warranted to confirm the safety and efficacy of these combined treatments in a larger patient population on NOACs.
- This case contributes to understanding the management of acute ischemic stroke in patients on novel oral anticoagulants.
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