BACKGROUND AND PURPOSE: Stent-retriever devices play an increasing role in the interventional treatment of acute stroke patients, because fast recanalization can be achieved. The purpose of this study was to evaluate the feasibility of stent-retriever recanalization in patients with wake-up stroke in the anterior circulation.

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Background and Purpose: Successful reperfusion during endovascular therapy (EVT) usually leads to early neurological improvement (ENI), yet some patients do not achieve good longterm outcome. The aim of this study was to investigate factors associated with unfavorable clinical outcome (UCO) despite ENI. Methods: This was a retrospective singlecenter analysis of consecutive patients treated for anterior circulation large vessel occlusion who achieved successful reperfusion and ENI (at least 20% lower followup NIHSS compared to NIHSS on admission) between 01/2014 and 04/2019. The primary endpoint was unfavorable outcome (90d mRS > 2 or mRS > baseline mRS). Patients with favorable clinical outcome (FCO) and UCO despite ENI were compared in univariable regression analysis. Results: Successful EVT (mTICI 2c or 3) and ENI occurred in 396/549 (72.1 %) patients and unfavorable outcome despite ENI in 168/396 (42.2 %) patients. Factors associated with UCO were baseline mRS (Odds ratio (OR) 3.13, p < 0.001), age (OR 1.09, p < 0.001), baseline NIHSs (OR 1.09, p < 0.001), female sex (OR 1.92, p = 0.002), hypertension (OR 2.32, p = 0.002), smoking (OR 0.48, p = 0.019), history of previous stroke (OR 2.7, p < 0.001), atrial fibrillation (OR 1.73, p = 0.007), neutrophil-lymphocyte ratio (OR 1.05, p = 0.014), as well as ASPECTS after EVT (OR 0.77, p < 0.001), TAN score (OR 0.60, p < 0.001) and Swieten score (OR 2.55, p < 0.001). Several ASPECTS regions were associated with UCO despite ENI (insula, M1-M3 and M5). Conclusions: Relevant factors associated with UCO despite successful EVT and ENI were patient age, sex, baseline mRS, hypertension, history of smoking, previous stroke, atrial fibrillation, neutrophil-lymphocyte ratio, TAN and Swieten Score as well as ASPECTS after EVT. The involvement of certain brain regions by ASPECTS segments were associated with UCO despite ENI after EVT.

Purpose: Elderly patients, especially octogenarians, are underrepresented in recently published studies, that showed a benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients and to identify independent outcome predictors. Methods: This is a retrospective, single-center analysis of patients treated for BAO with EST from 01/2013 until 06/2021 in a tertiary stroke center. Octogenarians were compared to younger patients. Study endpoint was the clinical outcome as per mRS 90 days after stroke onset. The study groups were compared in univariate analysis and a multivariate logistic regression analysis was performed to define independent predictors for clinical outcome. Results: In this study, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS (median, IQR 2, 1 - 3 vs. 0, 0 - 1 in younger patients, p < 0.001) and a comparable NIHSS before EST (median, IQR 21, 8 - 34 vs. 22, 10 - 38 in younger, p = 0.712). They showed a comparable mRS 90d after stroke onset (median, IQR 5, 3-6 vs. 5, 2-6 in younger), p = 0.194), but less often a good clinical outcome (mRS 0-2: n = 27, 23% younger vs. n = 9, 11.7% octogenarians, p = 0.004). The rate of bad clinical outcome was comparable (mRS 5-6, n = 63, 46.7% younger vs. 39, 50.6% octogenarians, p = 0.194). Baseline NIHSS was a stable independent predictor for clinical outcome in both study groups (e.g. for bad clinical outcome: in octogenarians OR 1.04 CI 100 - 10.85, p = 0.0019, in younger OR 1.061, CI 1.027 - 1.098, p = 0.005) Conclusion: Octogenarians with acute BAO eligible for EST are less likely to be functionally independent at 90 days after stroke onset, but the rate of death or severe handicap is comparable to younger patients. The admission NIHSS predicts clinical outcome in both age groups.