Abstract T P13: Reversed Ischemic Attack (Ria): Proposal for a New Terminology in the Era of Thrombolytic Therapy

Abstract

Background and Purpose: Cerebral ischemic attacks are classically known to cause either permanent injury in the case of ‘stroke’ or transient dysfunction without permanent injury in the case of ‘TIA’. The latter occurs due to timely restoration of cerebral blood flow and implies a spontaneous process. With thrombolytic therapy (intravenous or intra-arterial) complete reperfusion is possible and can lead in some patients to complete reversal of the ischemic insult both clinically and radiographically. This entity is inadequately characterized by the current stroke terminology. Methods: A retrospective review of a prospectively maintained database identified 800 patients who underwent acute endovascular reperfusion therapy. Inclusion criteria were: complete clinical recovery without evidence of infarction on follow up MRI (DWI sequence). Results: We identified 8 patients. Intravenous alteplase followed by intra-arterial therapy was administered in 37.5% of cases. Admission NIHSS ranged from 8-21 and recanalization occurred between 45-490 minutes of symptom onset. The site of occlusion was as follows: left internal carotid artery terminus (2, 25%), middle cerebral artery M1 segment (5, 62.5%) and middle cerebral artery M2 segment (1, 12.5%). Conclusions: A hitherto unreported condition of complete clinical and radiographic recovery after reperfusion therapy for large vessel intracranial occlusion is being described. Review of an endovascular database comprising 800 consecutive cases, revealed that the incidence of this entity is 1%. We postulate that in parallel to an increase in efficacy and utilization of revascularization modalities along with an increase in assessment of vessel patency prior to intravenous thrombolysis, recognition of this phenomenon will increase and propose the term ‘Reversed’ Ischemic Attack (RIA) to address a deficiency in terminology currently associated with this condition.