Precision Medicine and Stroke Rehabilitation in Atrial Fibrillation: Exploring the Multidimensional Impacts of Vessel Occlusion, Age, and Treatment

As the global population ages, atrial fibrillation (AF), a common cardiovascular condition, has gained attention for its association with ischemic stroke. Stroke in AF patients significantly increases mortality and disability. Intracranial vessel occlusion, especially in large cerebral arteries, is the main cause of AF-related ischemic stroke, leading to cerebral hypoxia and irreversible damage, which severely impacts functional outcomes.1 Recent studies have focused on using imaging techniques to predict stroke outcomes in AF patients, particularly evaluating the impact of vessel occlusion on functional recovery. We were highly interested in the study by Benz et al.,2 which, based on a large multicenter cohort, identified intracranial vessel occlusion in ischemic stroke patients with AF and examined its impact on functional outcomes. Vessel occlusion was assessed using computed tomography (CT) and magnetic resonance imaging (MRI) angiography, while functional recovery was analyzed through the modified Rankin Scale (mRS) and Barthel Index (BI). The study found that patients with vessel occlusion had worse mRS scores at 90 days, slower functional recovery, and higher disability risk. BI assessments showed slower recovery of daily activities and greater functional impairment. While this study provides valuable quantitative markers for post-stroke prognosis in AF patients, further research is needed. The study lacked analysis of post-stroke rehabilitation variations, such as physical, speech, and cognitive therapy, which are vital for long-term recovery. It also missed detailed age-based subgroup analysis, limiting generalizability, as older patients often face slower recovery due to reduced brain plasticity and higher complication risks.3 Additionally, it did not distinguish between complete and partial vessel occlusion, with the former typically leading to larger infarcts and slower recovery. Intracranial vascular anatomical differences, such as aneurysms or arteriovenous malformations, may also influence outcomes.4 Finally, varying treatment protocols across centers, particularly for thrombectomy and thrombolysis, could affect comparability. Future research should focus on rehabilitation as a key factor, examining how different interventions affect recovery in stroke patients with atrial fibrillation. Age-based stratification is crucial for developing targeted treatments. Additionally, the differences between complete and partial vessel occlusion should be explored, incorporating cerebrovascular hemodynamics to evaluate the impact of vascular status on recovery and support personalized care. Combining angiography with 3D reconstruction can reveal how anatomical variations influence outcomes, optimizing treatment strategies. Lastly, studies should investigate the combined effects of vascular occlusion and microcirculatory dysfunction, using microcirculation imaging and diffusion tensor imaging to explore the link between microcirculatory recovery and brain function restoration, advancing personalized rehabilitation and precision medicine. None. X.Y. and R.L. contributed to the conception and design of the study. X.Y. and J.S. were involved in drafting the manuscript. All authors participated in literature review and contributed to the final approval of the manuscript. Nothing to report.