Recanalization with Stent-Retriever Devices in Patients with Wake-Up Stroke

Abstract

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.

Treatment Concepts for Wake-Up Stroke and Stroke With Unknown Time of Symptom Onset

“…34,36 For both case series, overall results are not compelling with high mortality (23% and 37%) and high rates of symptomatic intracranial hemorrhage (14% and 21%) for both studies, while with regard to good outcome (mRS, 0-2 at day 90), the results were different with 48% 34 in one case series and only 11% in the other case series. 36 The majority of reports do not provide information on the timing of interventions.…”

“…34,36 For both case series, overall results are not compelling with high mortality (23% and 37%) and high rates of symptomatic intracranial hemorrhage (14% and 21%) for both studies, while with regard to good outcome (mRS, 0-2 at day 90), the results were different with 48% 34 in one case series and only 11% in the other case series. 36 The majority of reports do not provide information on the timing of interventions. In 1 study, median door to needle time for intravenous thrombolysis that was performed before intraarterial treatment was 154 minutes, which was significantly longer than in a comparison group of patients with known onset stroke screened by the same imaging approach (94 minutes).…”

“…Penumbral imaging using CTP or MRI was used in all these case series as far as reported. [32][33][34][35][36] Reported case numbers range between 19 and 83 with mean or median National Institutes of Health Stroke Scale values of 13 to 17. For all reports involving endovascular stroke treatment, rates of good outcome range between 11% and 50%, whereas mortality lies between 10% and 37%.…”

Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke

“…Recently, several trials emphasized the importance of patient selection for reperfusion therapy, with the tissue clock shown by multiparametric MR imaging techniques. [6][7][8][9]12 We selected, in our study, patients using DWI/FLAIR mismatch and clinical-diffusion mismatch among MR imaging criteria. As reported by Thomalla et al, 3 a patient with an acute ischemic lesion detected with DWI but not with FLAIR imaging is likely to be within 4.5 hours of symptom onset with high specificity (78%; 95% CI, 72%-84%) and high positive predict value (83%; 95% CI, 79%-88%).…”

“…[4][5][6][7][8][9] Only a few reports have evaluated the feasibility of endovascular therapies in patients with wake-up stroke. [10][11][12] Recently, randomized studies have demonstrated that mechanical thrombectomy is an alternative and synergistic method of treatment to IVT in acute ischemic stroke, with a higher recanalization rate (66%-100%) and a more favorable outcome (32.6%-71%). [13][14][15][16][17] The aim of this study was to describe the experience of our center with 41 patients presenting with a stroke of an unknown time of symptom onset in the anterior circulation, who were treated by using a coalescent stroke-management protocol with IVT, mechanical thrombectomy, or bridging therapy based on DWI/FLAIR mismatch.…”