Clinical efficacy and safety of endovascular treatment for patients with wake-up stroke with large vessel occlusion guided by NCCT-ASPECTS

Abstract

Objective

To evaluate the clinical efficacy and safety of 6 to 24 h endovascular therapy (EVT) in patients with wake-up stroke (WUS) with acute large vessel occlusion (LVO) of the anterior circulation guided by noncontrast computed tomography-Alberta stroke program early CT score (NCCT-ASPECTS).

Methods

Fifty-three patients with WUS with acute LVO of the anterior circulation who were treated at the Sir Run Run Shaw Hospital of Zhejiang Medical College from January 2018 to March 2021 were retrospectively analyzed. The patients were divided into NCCT-ASPECTS or CT perfusion groups. Baseline data, perioperative data, and 90-d prognostic information were compared between the two groups. Multivariable logistic regression analysis was used to determine the independent factors influencing outcomes.

Results

There were no significant differences in the good prognosis, symptomatic intracranial hemorrhage, and mortality rates between the two groups (P > 0.05). Multivariate logistic regression analysis showed that the puncture-recanalization time was an independent factor for good prognosis.

Conclusion

Based on NCCT-ASPECTS guidance, EVT in patients with WUS for acute LVO of the anterior circulation within 6 to 24 h may be safe and effective.

Keywords

Large vessel occlusion wake-up stroke endovascular therapy

Get full access to this article

View all access options for this article.

References

Mackey

Kleindorfer

Sucharew

, et al. Population-based study of wake-up strokes. Neurology 2011; 76: 1662–1667.

Moradiya

Janjua

. Presentation and outcomes of “wake-up strokes” in a large randomized stroke trial: analysis of data from the International Stroke Trial. J Stroke Cerebrovasc Dis 2013; 22: e286–e292.

Zhang

Wang

, et al. Wake-up stroke: imaging-based diagnosis and recanalization therapy. J Neurol. 2021;268(11):4002–4012.

Powers

Rabinstein

Ackerson

, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50: e344–e418.

Vagal

Wintermark

Nael

, et al. Automated CT perfusion imaging for acute ischemic stroke: pearls and pitfalls for real-world use. Neurology 2019; 93: 888–898. Epub 2019 Oct 21. PMID:31636160.

Haussen

Dehkharghani

Rangaraju

, et al. Automated CT perfusion ischemic core volume and noncontrast CT ASPECTS (Alberta Stroke Program Early CT Score): correlation and clinical outcome prediction in large vessel stroke. Stroke 2016; 47: 2318–2322.

Barber

Demchuk

Zhang

, et al. 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. Lancet 2000; 355: 1670–1674.

Santos

Carvalho

Cunha

, et al. NCCT and CTA-based imaging protocol for endovasculartreatment selection in late presenting or wake-up strokes. J Neurointerv Surg 2019; 11: 200–203.

Xianxian

. Research progress of circadian rhythm and reperfusion therapy in wake-up stroke. Chin J Neurol 2020; 53: 55–60.

10.

Rebello

Bouslama

Haussen

, et al. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. Eur J Neurol 2017; 24: 762–767.

11.

Schroder

Thomalla

. A critical review of Alberta Stroke Program Early CT Score for evaluation of acute stroke imaging. Front Neurol 2017; 7: 245. Published 2017 Jan 12.

12.

Kawiorski

Martínez-Sánchez

García-Pastor

, et al. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke. Neuroradiology 2016; 58: 487–493.

13.

Nogueira

Haussen

Liebeskind

, et al. Trevo registry and DAWN trial investigators. Stroke imaging selection modality and endovascular therapy outcomes in the early and extended time windows. Stroke 2021; 52: 491–497.

14.

Konstas

Minaeian

Ross

. Mechanical thrombectomy in wake-up strokes: a case series using Alberta Stroke Program Early CT Score (ASPECTS) for patient selection. J Stroke Cerebrovasc Dis 2017; 26: 1609–1614.

15.

Mulder

MJHL

Ergezen

Lingsma

, et al. Baseline blood pressure effect on the benefit and safety of intra-arterial treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in The Netherlands). Stroke 2017; 48: 1869–1876.

16.

Lowhagen Henden

Rentzos

Karlsson

, et al. Hypotension during endovascular treatment of ischemic stroke is a risk factor for poor neurological outcome. Stroke 2015; 46: 2678–2680.

17.

Chung

Kim

Kang

, et al. Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke. J Hypertens 2015; 33: 2099–2106.

18.

Nogueira

Liebeskind

Sung

, et al. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and multi MERCI trials. Stroke 2009; 40: 3777–3783.

19.

Nofzinger

Buysse

Miewald

, et al. Human regional cerebral glucose metabolism during non-rapid eye movement sleep in relation to waking. Brain 2002; 125: 1105–1115.