Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score \u2264\u20095 can benefit from endovascular treatment: a single-center experience and literature review

Hongyu Qiao,Jianye Liang,Wenxian Li,Li’An Huang,Kangping Song,Changzheng Shi,Xiaomei Xie,Min Guan,Zhen Jing

doi:10.1007/s00234-019-02177-1

Abstract

PurposeThe recommendation strength of the guidelines for mechanical thrombectomy among patients with large pre-treatment core infarct is weak. We evaluated the safety and outcome of endovascular treatment for acute ischemic stroke with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤ 5.MethodsData on acute ischemic stroke patients with DWI-ASPECTS ≤ 5 who underwent endovascular treatment within 6 h, or presented an arterial spin labeling-DWI (ASL-DWI) mismatch within 12 h, at our center were retrospectively collected. We report the clinical characteristics and outcome of every patient, and review the relevant literature.ResultsAmong the 19 patients who were enrolled, all experienced successful reperfusion, and 10 achieved a favorable outcome (modified Rankin scale (mRS) ≤ 2). Two patients presented with symptomatic intracranial hemorrhage (sICH); both of them had a poor outcome (mRS > 2).ConclusionAcute ischemic stroke patients with large DWI lesions caused by large vessel occlusion can achieve a favorable clinical outcome with endovascular treatment if recanalization is performed within 6 h, or after 6 h in case of an ASL-DWI mismatch.

Highlights

With 5.9 million deaths and 102 million disability-adjusted life years (DALYs) lost, stroke is the second leading cause of death and the third leading cause of DALYs lost worldwide [1]
We retrospectively reviewed all patients with acute anterior circulation infarcts, as identified by MRI and digital subtraction angiography (DSA), who received endovascular treatment (EVT) at the First Affiliated Hospital of Jinan University from September 2016 to June 2018
Twelve patients were treated with EVT within 6 h, but in three of them, information regarding an arterial spin labeling-DWI (ASL-DWI) mismatch could not be obtained

Summary

Introduction

With 5.9 million deaths and 102 million disability-adjusted life years (DALYs) lost, stroke is the second leading cause of death and the third leading cause of DALYs lost worldwide [1]. Large infarctions account for 7.6% of all ischemic strokes. Intravenous thrombolysis (IVT) is a generally accepted effective therapy for acute ischemic stroke (AIS), but it has a low rate of recanalization for large vessel occlusion (LVO). A series of multi-center randomized clinical trials (MR CLEAN, EXTEND-IA, REVASCAT, SWIFT PRIME, and ESCAPE) [5,6,7,8,9] showed that mechanical thrombectomy with a stent retriever improves the functional outcome of patients with ischemic stroke caused by proximal vessel occlusion, compared with IVT alone, leading to neurointervention in combination with IVT as a first-line therapy for acute LVO in the anterior circulation. The representative, multi-center clinical trials [7,8,9] used massive cerebral infarction as an exclusion criterion, with the result of endovascular treatment (EVT) being deemed unsuitable for treatment, or having Buncertain benefits,^ in these cases, according to an update in the endovascular treatment guidelines in Europe and the USA

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Results

Conclusion