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million in Japan.10 In this issue of the Journal, Suda and colleagues11 report changes in anticoagulation, treatment, and functional outcomes among acute ischemic stroke patients with nonvalvular AF from 2011 to 2017 using a single-center prospective stroke registry. The study period was set between the year of approval of the first direct oral anticoagulant (DOAC) in Japan and 2 years after the establishment of endovascular thrombectomy within 6 h of stroke onset. They clearly show a steady increase in reperfusion therapy (intravenous thrombolysis (IVT), endovascular treatment (EVT) or IVT+EVT) over time. Particularly in patients with moderate-to-severe stroke (initial National Institutes of Health Stroke Scale ≥10), EVT alone and IVT+EVT increased and unfavorable outcomes, including death at discharge, decreased during the study period. Multivariate logistic regression analyses revealed reperfusion therapy [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.39– 12.87] as independently and positively associated with good functional outcomes (mRS ≤2) at discharge. IVT+EVT (OR, 0.13; 95% CI, 0.0008–0.69) was independently and negatively associated with death. Because temporal trend data for acute stroke management are limited, this report could reflect current clinical performance in an EVT-capable comprehensive stroke center. Although this was an C onsiderable changes in acute stroke management have occurred since evidence for the benefits of endovascular thrombectomy in acute ischemic stroke patients with major vessel occlusion within 6 h of onset was established in 2015.1–5 The number needed to treat with endovascular thrombectomy to reduce disability by at least 1 level on the modified Rankin Scale [mRS, which ranges from 0 (no symptoms) to 6, with mRS 5 indicating severe disability and mRS 6 indicating death] was only 2.6.6 The sooner endovascular thrombectomy is performed after stroke symptom onset, the better the functional outcomes that can be expected, according to a meta-analysis.7 Endovascular thrombectomy is the key component of acute stroke management and extensive efforts are underway to reduce delays to revascularization both in Japan and worldwide. Atrial fibrillation (AF) is a major contributor to ischemic stroke. According to the Japan Standard Stroke Registry Study, cardioembolic stroke, mainly caused by AF, accounts for 28% of all ischemic strokes. Importantly, around 50% of patients in Japanese reperfusion studies and large vessel occlusion (LVO) registries have AF (Table).8,9 These rates appear high as compared with those in other trials.1–5 One reason for this deviation may be the super-aging population in Japan. The rate of AF increases linearly after 50 years in the general population and the prevalence beyond 80 years old is 4.4% in men and 2.2% in women, and the estimated total number of patients with AF is approximately 0.9 Article p ????

More Benefits From Endovascular Thrombectomy in Patients With Atrial Fibrillation?