Late endovascular revascularization in acute ischemic stroke based on clinical-diffusion mismatch

Area of Science:

• Neurology
• Interventional Radiology
• Emergency Medicine

Background:

• A clinical-diffusion mismatch (CDM) in stroke patients presenting within 12-24 hours is linked to worsening symptoms and larger infarcts.
• Identifying suitable candidates for reperfusion therapy is crucial for improving outcomes.

Purpose of the Study:

• To assess the feasibility and safety of reperfusion therapy in stroke patients with a clinical-diffusion mismatch presenting beyond 8 hours.
• To evaluate the impact of endovascular treatment on neurologic status and intracranial hemorrhage.

Main Methods:

• Eleven patients with large vessel syndromes, NIHSS score >=8, and limited diffusion abnormalities on MRI beyond 8 hours were included.
• Revascularization therapy was considered. Early neurologic deterioration (END) and early neurologic improvement (ENI) were assessed using NIHSS scores at 1 and 7 days.
• Follow-up imaging evaluated for intracranial hemorrhage (ICH).

Main Results:

• Eight of eleven patients (72%) were successfully revascularized.
• Successfully revascularized patients showed significant improvement in NIHSS scores at 24 hours and 1 week.
• Eight treated patients (100% of those revascularized) experienced ENI; no patients had END or ICH.

Conclusions:

• Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and safe in patients meeting CDM criteria.
• This therapy may prevent early neurologic deterioration and promote early neurologic improvement.
• A prospective study is planned to further validate these findings.