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Updated: Jun 27, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Endovascular thrombectomy in wake-up stroke guided by arterial spin-labeling and fluid-attenuated inversion recovery
Hong-Feng Wen1, Qin Li1, Pei-Fu Wang2
1Department of Neurology, Aerospace Center Hospital, No. 15 Yuquan Road, Haidian District, Beijing, 100049, China.
Objective:
This purpose of this study is to investigate the effectiveness and safety of utilizing the arterial spin-labeling (ASL) combined with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) combined with DWI double mismatch in the endovascular treatment of patients diagnosed with wake-up stroke (WUS).
Methods:
In this single-center trial, patients diagnosed with WUS underwent thrombectomy if acute ischemic lesions were observed on DWI indicating large precerebral circulation occlusion. Patients with no significant parenchymal hypersignal on FLAIR and ASL imaging showing a hypoperfusion tissue to infarct core volume ratio of at least 1.2 were included. The participants were divided into groups receiving endovascular thrombectomy plus medical therapy or medical therapy alone, based on their subjective preference. Functional outcomes were assessed using the ordinal score on the modified Rankin scale (mRs) at 90 days, along with the rate of functional independence.
Results:
In this study, a total of 77 patients were included, comprising 38 patients in the endovascular therapy group and 39 patients in the medical therapy group. The endovascular therapy group exhibited more favorable changes in the distribution of functional prognosis measured by mRs at 90 days, compared to the medical therapy group (adjusted common odds ratio, 3.25; 95% CI, 1.03 to 10.26; P < 0.01). Additionally, the endovascular therapy group had a higher proportion of patients achieving functional independence (odds ratio, 4.0; 95% CI, 1.36 to 11.81; P < 0.01). Importantly, there were no significant differences observed in the incidence of intracranial hemorrhage or mortality rates between the two groups.
Conclusion:
Guided by the ASL-DWI and FLAIR-DWI double mismatch, endovascular thrombectomy combined with standard medical treatment appears to yield superior functional outcomes in patients with WUS and large vessel occlusion compared to standard medical treatment alone.
Insights
Endovascular thrombectomy for wake-up stroke (WUS) guided by imaging mismatches significantly improves functional outcomes. This treatment is safe and effective, showing better results than medical therapy alone for WUS patients with large vessel occlusion.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Wake-up stroke (WUS) presents diagnostic challenges due to unknown onset time.
- Advanced imaging techniques are crucial for assessing WUS patients eligible for treatment.
- Identifying large vessel occlusions (LVOs) is critical for effective intervention.
Purpose of the Study:
- To evaluate the effectiveness and safety of endovascular thrombectomy in WUS patients.
- To assess the utility of arterial spin-labeling (ASL) and fluid-attenuated inversion recovery (FLAIR) combined with diffusion-weighted imaging (DWI) double mismatch criteria.
- To compare outcomes between endovascular therapy and medical therapy alone in WUS with LVO.
Main Methods:
- Single-center trial including 77 WUS patients with LVO.
- Inclusion criteria: DWI lesions, no significant FLAIR hypersignal, ASL imaging showing hypoperfusion to infarct core ratio ≥ 1.2.
- Patients randomized to endovascular thrombectomy plus medical therapy or medical therapy alone based on preference.
Main Results:
- Endovascular therapy group (38 patients) showed significantly better functional outcomes at 90 days (mRs: OR 3.25, P<0.01) compared to medical therapy (39 patients).
- Higher functional independence rates observed in the endovascular therapy group (OR 4.0, P<0.01).
- No significant differences in intracranial hemorrhage or mortality between groups.
Conclusions:
- ASL-DWI and FLAIR-DWI double mismatch criteria effectively identify WUS patients who benefit from endovascular thrombectomy.
- Endovascular thrombectomy combined with medical treatment offers superior functional outcomes for WUS with LVO compared to medical therapy alone.
- The combined imaging approach ensures safety and efficacy in WUS treatment selection.
