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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Mechanical embolectomy for acute ischemic stroke beyond six hours from symptom onset using MRI based perfusion
Ryan A McTaggart1, Shadi Yaghi2, Daniel C Sacchetti2
1Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
Journal of the Neurological Sciences
|March 22, 2017
Summary
MRI perfusion imaging helps select acute ischemic stroke patients with large vessel occlusion for mechanical embolectomy beyond 6 hours. Favorable imaging identified patients who achieved good outcomes, similar to endovascular trial results.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Limited data exists on using MRI perfusion imaging for selecting acute ischemic stroke patients with large vessel occlusion (LVO) for intra-arterial therapy beyond 6 hours.
- Mechanical embolectomy is a key treatment for LVO, but optimal patient selection beyond the standard time window remains challenging.
Purpose of the Study:
- To evaluate the outcomes of patients with acute ischemic stroke and proximal LVO who presented beyond 6 hours from symptom onset.
- To assess the efficacy of mechanical embolectomy in patients selected by MRI perfusion imaging criteria.
- To determine if MRI perfusion imaging can identify suitable candidates for reperfusion therapy in the extended time window.
Main Methods:
- Retrospective study of 41 patients with acute ischemic stroke and proximal LVO between December 2015 and July 2016.
- Patients presented between 6-24 hours from symptom onset with CT ASPECTS of 6 or more.
- Selection for mechanical embolectomy was based on a favorable MRI perfusion imaging profile: DWI lesion volume ≤70ml, penumbra volume ≥15ml, mismatch ratio ≥1.8, and perfusion lesion volume <100ml.
Main Results:
- 22 patients (53.7%) had a favorable MRI imaging profile and underwent mechanical embolectomy.
- The rate of good outcomes (90-day mRS ≤2) was 63.6%, which was similar to pooled meta-analysis results from endovascular trials (46%, p=0.13).
- No symptomatic intracerebral hemorrhage occurred in the studied cohort.
Conclusions:
- MRI perfusion imaging may effectively select patients with acute ischemic stroke and proximal LVO for mechanical embolectomy beyond the conventional 6-hour treatment window.
- These findings support the use of advanced imaging in ongoing trials for endovascular treatment in this patient population.
- Stroke centers should consider participating in trials utilizing advanced imaging for extended window stroke treatment.
