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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Cervicocerebral atherosclerosis and atrial fibrillation increase long-term mortality in patients with ischemic stroke

Kati Lainelehto1, Juha-Pekka Pienimäki2, Sirpa Savilahti2

  • 1Emergency Department Acuta, Tampere University Hospital, Wellbeing services of Pirkanmaa, PL 2000, 33521 Tampere, Finland.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|December 21, 2025
PubMed

Insights

Atrial fibrillation (AF) and brain artery atherosclerosis increase stroke risk. Concurrent AF and high atherosclerotic burden significantly elevate long-term mortality in stroke patients.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Atrial fibrillation (AF) and cerebrovascular atherosclerosis are key risk factors for ischemic events.
  • The combined impact of AF and atherosclerosis on long-term mortality after acute ischemic stroke or TIA remains understudied.

Purpose of the Study:

  • To investigate the association between concurrent atrial fibrillation (AF) and cervicocerebral atherosclerotic burden (CAB) with long-term mortality in patients with acute ischemic stroke or TIA.
  • To quantify the independent and combined effects of AF and CAB on mortality risk.

Main Methods:

  • 406 patients with acute ischemic stroke or TIA underwent computed tomography angiography (CTA) to assess cervicocerebral arteries.
  • Cervicocerebral Atherosclerotic Burden (CAB) score was calculated, and patients were analyzed based on AF status and CAB score quartiles.

Main Results:

  • Long-term follow-up (median 7.3 years) revealed significantly higher mortality in patients with AF (52.0%) compared to those without AF (27.0%).
  • In AF patients, the two highest CAB score quartiles were independently associated with increased mortality (HRs 12.7 and 15.8).
  • A combined analysis showed a 3-fold increased mortality risk in AF patients with high CAB scores compared to those without AF and low CAB scores.

Conclusions:

  • Elevated atherosclerotic burden in brain-supplying arteries is a significant independent predictor of long-term mortality in patients with acute ischemic stroke or TIA and concurrent AF.
  • The combination of AF and substantial cervicocerebral atherosclerosis poses a particularly high mortality risk.
Abstract

Keywords:
AtherosclerosisAtrial fibrillationIntracranial arteriosclerosisMortalityStroke

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