Recanalization with stent-retriever devices in patients with wake-up stroke

Area of Science:

• Neurology
• Interventional Neuroradiology
• Acute Stroke Management

Background:

• Stent-retriever devices are increasingly used for acute stroke treatment due to their ability to achieve rapid recanalization.
• Wake-up strokes present unique challenges in treatment initiation and outcome prediction.

Purpose of the Study:

• To assess the feasibility and outcomes of using stent-retriever devices for recanalization in anterior circulation wake-up stroke patients.
• To evaluate the safety and efficacy of this interventional approach in a specific stroke population.

Main Methods:

• Retrospective analysis of 19 consecutive wake-up stroke patients treated with stent-retriever devices (2009-2011).
• Assessment of recanalization using the Thrombolysis in Cerebral Infarction (TICI) score.
• Clinical outcome evaluation at discharge and 90 days using the modified Rankin Scale (mRS).

Main Results:

• Successful recanalization (TICI ≥ 2) was achieved in 94.7% of patients.
• Mean time to flow restoration was 36.7 minutes; mean time to complete recanalization was 83.7 minutes.
• Poor clinical outcomes were observed: 10.5% achieved good outcome (mRS 0-2) at 90 days, and 36.8% died. Symptomatic intracranial hemorrhage occurred in 21.1%.

Conclusions:

• While stent-retriever devices enable rapid recanalization in wake-up strokes, good clinical outcomes are infrequent.
• The rate of bleeding complications was higher compared to procedures performed within 6 hours of stroke onset.
• Clinical outcomes for wake-up stroke patients treated with stent-retrievers remain poor, highlighting the need for improved therapeutic strategies.