Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch

• Published in: American journal of neuroradiology : AJNR 2009-05, Vol.30 (5), p.1024-1027
• Main Authors: Janjua, N, El-Gengaihy, A, Pile-Spellman, J, Qureshi, A.I
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - prevention & control; Cerebral Revascularization - methods; Child; Diffusion Magnetic Resonance Imaging - methods; Feasibility Studies; Female; Fibrinolytic Agents - therapeutic use; Humans; Interventional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Nervous system involvement in other diseases. Miscellaneous; Neurology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Stroke - complications; Stroke - diagnosis; Stroke - therapy; Thrombolytic Therapy - methods; Treatment Outcome; Young Adult
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1474

A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12-24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion. Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored > or =8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by > or =4 points) and early neurologic improvement (ENI, decrease in NIHSS score by > or =4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH). Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 +/- 4, 11 +/- 7, and 6 +/- 5, respectively, with lower scores at 24 hours and 1 week (8 +/- 5 and 4 +/- 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH. Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criteria of a CDM. A prospective study is planned.