Skip to main content
Top

25-04-2024 | Thrombectomy

Endovascular thrombectomy in wake-up stroke guided by arterial spin-labeling and fluid-attenuated inversion recovery versus diffusion-weighted imaging mismatch on MRI

Authors: Hong-Feng Wen, Qin Li, Pei-Fu Wang, Ji-Lai Li, Ji-Chen Du

Published in: Journal of Thrombosis and Thrombolysis

Login to get access

Abstract

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.
Literature
2.
go back to reference Albers GW, Marks MP, Kemp S et al (2018) DEFUSE 3 investigators. Thrombectomy for Stroke at 6 to 16 hours with selection by Perfusion Imaging. N Engl J Med 378(8):708–718CrossRefPubMedPubMedCentral Albers GW, Marks MP, Kemp S et al (2018) DEFUSE 3 investigators. Thrombectomy for Stroke at 6 to 16 hours with selection by Perfusion Imaging. N Engl J Med 378(8):708–718CrossRefPubMedPubMedCentral
3.
go back to reference Nogueira RG, Jadhav AP, Haussen DC et al (2018) DAWN trial investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between Deficit and Infarct. N Engl J Med 378(1):11–21CrossRefPubMed Nogueira RG, Jadhav AP, Haussen DC et al (2018) DAWN trial investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between Deficit and Infarct. N Engl J Med 378(1):11–21CrossRefPubMed
4.
go back to reference Goyal M, Menon BK, van Zwam WH et al (2016) HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five XXXandomized trials. Lancet 387(10029):1723–1731CrossRefPubMed Goyal M, Menon BK, van Zwam WH et al (2016) HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five XXXandomized trials. Lancet 387(10029):1723–1731CrossRefPubMed
5.
go back to reference Powers WJ, Derdeyn CP, Biller J, American Heart Association Stroke Council (2015) 2015 American Heart Association/American Stroke Association Focused Update of the 2013 guidelines for the early management of patients with Acute ischemic stroke regarding endovascular treatment: a Guideline for Healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(10):3020–3035CrossRefPubMed Powers WJ, Derdeyn CP, Biller J, American Heart Association Stroke Council (2015) 2015 American Heart Association/American Stroke Association Focused Update of the 2013 guidelines for the early management of patients with Acute ischemic stroke regarding endovascular treatment: a Guideline for Healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(10):3020–3035CrossRefPubMed
6.
go back to reference Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score [published correction appears in Lancet. ;355(9221):2170]. Lancet. 2000;355(9216):1670–1674 Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score [published correction appears in Lancet. ;355(9221):2170]. Lancet. 2000;355(9216):1670–1674
7.
go back to reference Lansberg MG, Christensen S, Kemp S et al (2017) CT perfusion to predict response to recanalization in ischemic Stroke Project (CRISP) investigators. Computed tomographic perfusion to predict response to recanalization in ischemic stroke. Ann Neurol 81(6):849–856CrossRefPubMedPubMedCentral Lansberg MG, Christensen S, Kemp S et al (2017) CT perfusion to predict response to recanalization in ischemic Stroke Project (CRISP) investigators. Computed tomographic perfusion to predict response to recanalization in ischemic stroke. Ann Neurol 81(6):849–856CrossRefPubMedPubMedCentral
8.
go back to reference Cai H, Fan S, Bian Y et al (2022) Two-way comparison of brain perfusion image processing software for patients with acute ischemic strokes in real-world. Neuroradiology 64(1):161–169CrossRefPubMed Cai H, Fan S, Bian Y et al (2022) Two-way comparison of brain perfusion image processing software for patients with acute ischemic strokes in real-world. Neuroradiology 64(1):161–169CrossRefPubMed
9.
go back to reference Cho AH, Kim JS, Kim SJ et al (2008) Focal fluid-attenuated inversion recovery hyperintensity within acute diffusion-weighted imaging lesions is associated with symptomatic intracerebral hemorrhage after thrombolysis. Stroke 39(12):3424–3426CrossRefPubMed Cho AH, Kim JS, Kim SJ et al (2008) Focal fluid-attenuated inversion recovery hyperintensity within acute diffusion-weighted imaging lesions is associated with symptomatic intracerebral hemorrhage after thrombolysis. Stroke 39(12):3424–3426CrossRefPubMed
10.
go back to reference Kufner A, Galinovic I, Brunecker P et al (2013) Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis. Eur J Neurol 20(2):281–285CrossRefPubMed Kufner A, Galinovic I, Brunecker P et al (2013) Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis. Eur J Neurol 20(2):281–285CrossRefPubMed
11.
go back to reference Simard JM, Kent TA, Chen M et al (2007) Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol 6:258–268CrossRefPubMedPubMedCentral Simard JM, Kent TA, Chen M et al (2007) Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol 6:258–268CrossRefPubMedPubMedCentral
12.
go back to reference Álvarez-Sabín J, Maisterra O, Santamarina E et al (2013) Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol 12(7):689–705CrossRefPubMed Álvarez-Sabín J, Maisterra O, Santamarina E et al (2013) Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol 12(7):689–705CrossRefPubMed
13.
go back to reference Song SS, Latour LL, Ritter CH et al (2012) A pragmatic approach using magnetic resonance imaging to treat ischemic strokes of unknown onset time in a thrombolytic trial. Stroke 43(9):2331–2335CrossRefPubMedPubMedCentral Song SS, Latour LL, Ritter CH et al (2012) A pragmatic approach using magnetic resonance imaging to treat ischemic strokes of unknown onset time in a thrombolytic trial. Stroke 43(9):2331–2335CrossRefPubMedPubMedCentral
14.
go back to reference Schwamm LH, Wu O, Song SS et al (2018) MR WITNESS investigators. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Ann Neurol 83(5):980–993CrossRefPubMedPubMedCentral Schwamm LH, Wu O, Song SS et al (2018) MR WITNESS investigators. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Ann Neurol 83(5):980–993CrossRefPubMedPubMedCentral
15.
go back to reference Thomalla G, Simonsen CZ, Boutitie F et al (2018) WAKE-UP investigators. MRI-Guided thrombolysis for stroke with unknown time of Onset. N Engl J Med 379(7):611–622CrossRefPubMed Thomalla G, Simonsen CZ, Boutitie F et al (2018) WAKE-UP investigators. MRI-Guided thrombolysis for stroke with unknown time of Onset. N Engl J Med 379(7):611–622CrossRefPubMed
17.
go back to reference Olivot JM, Mlynash M, Thijs VN et al (2009) Optimal tmax threshold for predicting penumbral tissue in acute stroke. Stroke 40(2):469–475CrossRefPubMed Olivot JM, Mlynash M, Thijs VN et al (2009) Optimal tmax threshold for predicting penumbral tissue in acute stroke. Stroke 40(2):469–475CrossRefPubMed
18.
go back to reference Kidwell CS, Saver JL, Mattiello J et al (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47(4):462–469CrossRefPubMed Kidwell CS, Saver JL, Mattiello J et al (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47(4):462–469CrossRefPubMed
19.
go back to reference Bokkers RP, Hernandez DA, Merino JG et al (2012) National Institutes of Health Stroke Natural History Investigators. Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke 43(5):1290–1294CrossRefPubMedPubMedCentral Bokkers RP, Hernandez DA, Merino JG et al (2012) National Institutes of Health Stroke Natural History Investigators. Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke 43(5):1290–1294CrossRefPubMedPubMedCentral
20.
go back to reference Luo S, Yang L, Wang L (2015) Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke. J Neuroradiol 42(5):255–260CrossRefPubMed Luo S, Yang L, Wang L (2015) Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke. J Neuroradiol 42(5):255–260CrossRefPubMed
21.
go back to reference Haller S, Zaharchuk G, Thomas DL et al (2016) Arterial spin labeling perfusion of the brain: emerging clinical applications. Radiology 281(2):337–356CrossRefPubMed Haller S, Zaharchuk G, Thomas DL et al (2016) Arterial spin labeling perfusion of the brain: emerging clinical applications. Radiology 281(2):337–356CrossRefPubMed
22.
go back to reference Bivard A, Krishnamurthy V, Stanwell P et al (2014) Arterial spin labeling versus bolus-tracking perfusion in hyperacute stroke. Stroke 45(1):127–133CrossRefPubMed Bivard A, Krishnamurthy V, Stanwell P et al (2014) Arterial spin labeling versus bolus-tracking perfusion in hyperacute stroke. Stroke 45(1):127–133CrossRefPubMed
23.
go back to reference Bivard A, Stanwell P, Levi C et al (2013) Arterial spin labeling identifies tissue salvage and good clinical recovery after acute ischemic stroke. J Neuroimaging 23(3):391–396CrossRefPubMed Bivard A, Stanwell P, Levi C et al (2013) Arterial spin labeling identifies tissue salvage and good clinical recovery after acute ischemic stroke. J Neuroimaging 23(3):391–396CrossRefPubMed
24.
go back to reference Yang P, Zhang Y, Zhang L et al (2020) DIRECT-MT investigators. Endovascular thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med 382(21):1981–1993CrossRefPubMed Yang P, Zhang Y, Zhang L et al (2020) DIRECT-MT investigators. Endovascular thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med 382(21):1981–1993CrossRefPubMed
25.
go back to reference Goyal M, Menon BK, van Zwam WH et al (2016) HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731CrossRefPubMed Goyal M, Menon BK, van Zwam WH et al (2016) HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731CrossRefPubMed
26.
go back to reference Suzuki K, Kimura K, Takeuchi M et al (2019) The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study). Int J Stroke 14(7):752–755CrossRefPubMed Suzuki K, Kimura K, Takeuchi M et al (2019) The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study). Int J Stroke 14(7):752–755CrossRefPubMed
Metadata
Title
Endovascular thrombectomy in wake-up stroke guided by arterial spin-labeling and fluid-attenuated inversion recovery versus diffusion-weighted imaging mismatch on MRI
Authors
Hong-Feng Wen
Qin Li
Pei-Fu Wang
Ji-Lai Li
Ji-Chen Du
Publication date
25-04-2024
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-024-02973-4
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare