Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset

Bücke, Philipp; Pérez, Marta Aguilar; Hellstern, Victoria; AlMatter, Muhammad; Bäzner, Hansjörg; Henkes, Hans

doi:10.3174/ajnr.a5540

Cited by 18 publications

(12 citation statements)

References 35 publications

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“…In line with Guo et al [6] and Zhang et al [18], there appears to be no increased risk for ICH in patients with severe LA undergoing MT. In the present study, wake-up stroke was associated with ICH but not with sICH [30].…”

Section: Discussioncontrasting

confidence: 51%

Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Mutzenbach

Müller-Thies-Broussalis

Killer‐Oberpfalzer

et al. 2020

Cerebrovasc Dis

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Background: Severe leukoaraiosis (LA) is an established risk factor for poor outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke. There is uncertainty whether this association also applies to successfully recanalized patients with M1 segment middle cerebral artery (MCA) occlusions. Methods: A retrospective single-centre study of patients with successful reperfusion (thrombolysis in cerebral infarction, TICI 2b or 3) after MT for an M1 MCA occlusion was performed over a 7-year period. LA score (LAS) was assessed using the age-related white matter change scale on pre-interventional brain imaging. Results: A total of 209 patients (median age 75.0 years) were included. LAS was assessed on pre-interventional imaging by computed tomography in 177 (84.7%) patients and magnetic resonance imaging in 32 (15.3%) patients. The median LAS was 1 (IQR 0-8), and severe LA consisted of the top 25 percentile, ranging from 9 to 24. Multivariable analysis demonstrated an association of severe LA (OR 0.32, 95% CI 0.12-0.88, p = 0.023), higher NIHSS on admission (OR 0.89, 95% CI 0.84-0.94, p < 0.001), advanced age (OR 0.97, 95% CI 0.95-1.00, p = 0.039), good leptomeningeal collaterals (OR 3.65, 95% CI 1.46-8.15, p = 0.001), and TICI 3 score (OR 3.26, 95% CI 10.52-7.01) with good clinical outcome after 3 months as measured with the modified Rankin scale. Conclusion: Severe LA is associated with poor clinical outcome at 3 months in acute stroke patients undergoing MT due to emergent M1 MCA occlusion.

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Section: Discussioncontrasting

confidence: 51%

Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Mutzenbach

Müller-Thies-Broussalis

Killer‐Oberpfalzer

et al. 2020

Cerebrovasc Dis

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“…Thus, the comparability of these results to our data is limited. In contrast, Bücke et al showed that patients with daytime unwitnessed stroke, which included an unspecified proportion of LKWu patients, have a worse outcome 3 months after ET than patients with a known onset [12]; however, the multivariable analyses were not adjusted for the ASPECT score that we identified as key predictor, which may explain the difference to our results. Tortuyaux et al observed a comparable outcome of patients with unknown onset at 3 months, including 34% of LKWu patients, compared to controls with known onset after adjustment for confounders [13]; however, only a subset of patients in that study had LVOS and underwent ET, limiting comparability to our data.…”

Section: Discussioncontrasting

confidence: 92%

Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy

et al. 2022

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Purpose Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS. Methods We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome. Results Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score. Conclusion The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.

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“…Similar observations have been reported, where time to treatment did not affect the functional outcome at 3 months. [ 17 ] Our results reaffirm the fact that when selected based on tissue characteristics, delayed window patients perform as well as those presenting early in real world setting.…”

Section: Discussionsupporting

confidence: 79%

The Impact of Time to Reperfusion on Recanalization Rates and Outcome After Mechanical Thrombectomy

Sylaja

Sreedharan

Arun

et al. 2022

Annals of Indian Academy of Neurology

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Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Methods: The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019. Results: There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12–21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8–10) in 39 (31.6%) and fair (5–7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (<6 h) versus wake up strokes and late presenting patients (81.79% vs 71.9%). Symptomatic Intracerebral hemorrhage (ICH) occurred in 5%. At 3 months, excellent outcome (modified rankin scale <2) was observed in 28.9%. While Admission NIHSS remained strong predictor of poor outcome at 3 months, delay in presentation did not impact MT outcome (37.5% vs 45.79% and P = 0.460). Conclusions: The recanalization rates were similar in patients irrespective of the time to reperfusion from stroke onset. The functional outcome was not inferior in late presenters selected by advanced imaging.

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Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset

Cited by 18 publications

References 35 publications

Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Severe Leukoaraiosis Is Associated with Poor Outcome after Successful Recanalization of M1 Middle Cerebral Artery Occlusion Strokes

Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy

The Impact of Time to Reperfusion on Recanalization Rates and Outcome After Mechanical Thrombectomy

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