Clinical and imaging outcomes after stroke with normal angiograms

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Prognosis data for acute ischemic stroke patients with normal cerebral angiography is scarce.
• Thrombolytic therapy is a key treatment for acute ischemic stroke, but its use in patients with normal angiography requires further investigation.

Purpose of the Study:

• To investigate the clinical and imaging outcomes of acute ischemic stroke patients who presented within 6 hours of symptom onset and had normal cerebral angiograms.
• To evaluate the potential mechanism of normal angiograms in this patient cohort.

Main Methods:

• Retrospective analysis of 21 acute ischemic stroke patients who underwent cerebral angiography within 6 hours of symptom onset and showed no occlusive disease.
• Clinical outcomes were assessed using the modified Rankin Scale (mRS), and imaging outcomes were evaluated via CT or MR imaging at follow-up.
• National Institutes of Health Stroke Scale (NIHSS) scores were recorded on admission.

Main Results:

• Approximately 76% of patients experienced a favorable clinical outcome (mRS ≤2) at discharge or follow-up.
• New infarcts on follow-up imaging were observed in 71% of patients.
• Discharge mRS scores did not correlate with admission NIHSS scores or the presumed mechanism of the normal angiogram.

Conclusions:

• A significant majority of acute ischemic stroke patients with normal angiograms achieve favorable clinical outcomes.
• Despite good clinical outcomes, a high incidence of new infarctions is noted on follow-up imaging.
• Further research is warranted to establish evidence-based recommendations for thrombolytic treatment in this specific patient group.