Background & Purpose: Carotid stenosis (CS) and atrial fibrillation (AF) can be associated with a bad outcome even in minor stroke. We investigated acute stroke recurrence and short-term outcome in Japanese minor stroke patients with CS with or without AF.
Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 48 hurs after the onset, 429 patients with acute ischemic stroke with extracranial carotid stenosis (50% or more in diameter measured by using MR angiography or carotid ultrasonography), the initial NIH stroke scale (NIHSS) score of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. Patients who were planned for carotid endarterectomy within 3 weeks were excluded. We observed a stroke recurrence and outcome during 3 months. Stroke recurrence was defined as a neurological deterioration (NIHSS score worsening of ≥1 point) with a new ischemic lesion on diffusion weighted image. Good outcome was defined as a mRS score of 0 or 1 at 3 months.
Results: AF was observed in 94 (22%) patients at hospital discharge. The acute stroke recurrence rate was not different between patients with (11%) and without AF (12%), however, good outcome was less frequent in patients with (39%) than without AF (66%). The Degree of carotid stenosis in NASCET method was more severe in patients with than without acute stroke recurrence (66% vs 59%). The initial diastolic blood pressure, pulse rate, NIHSS Score, WBC, TG, glucose, HbA1c, CRP, and D-dimer values were lower in patients with than without good outcome at 3 months. On the multivariate analysis, AF was negatively associated with good outcome (OR 0.36, 95%CI 0.20-0.0.64). The initial D-dimer value (OR 0.84, 95%CI 0.75-0.94) was also negatively associated with good outcome. Among 94 patients with both CS and AF, combined treatment with both antiplatelet and anticoagulant agents was more frequent in patients with than without good outcome.
Conclusions: AF and the initial D-dimer value were significant negative predictors for good outcome in patients with CS. Optimal antithrombotic treatment in patients with both CS and AF should be investigated.