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AJNR - American Journal of Neuroradiology

Publication Preview: Published February 4, 2009

American Journal of Neuroradiology 2009;30:1024.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1474

INTERVENTIONAL

Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch

N. Janjua, A. El-Gengaihy, J. Pile-Spellman and A.I. Qureshi

From the Department of Neurology (N.J.), Division of Interventional and Critical Care Neurology, Long Island College Hospital and Department of Neurology, State University of New York Health Sciences Center, Downstate Campus, Brooklyn, NY; Department of Neurology (A.E.-G.), University of Medicine and Dentistry New Jersey, Newark, NJ; Department of Radiology (J.P.-S.), Columbia University Medical Center, New York, NY; and Department of Neurology (A.I.Q.), Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minn.

Please address correspondence to N. Janjua, MD, Long Island College Hospital, Neurology, 339 Hicks St, Brooklyn, NY, 11201; e-mail: NJanjua{at}chpnet.org

BACKGROUND AND PURPOSE: A clinical-diffusion mismatch (CDM) among stroke patients presenting within 12–24 hours has been correlated with neurologic deterioration and infarct expansion. We sought to study the feasibility and safety of reperfusion therapy in a series of 11 consecutive patients fulfilling this criterion.

MATERIALS AND METHODS: Patients presenting with large vessel syndromes were considered for revascularization therapy. Of these patients, we identified those presenting beyond 8 hours who scored 8 on the National Institutes of Health Stroke Scale (NIHSS) and had limited abnormalities on diffusion-weighted MR imaging. One- and 7-day NIHSS scores were obtained. Rates of early neurologic deterioration (END, increase in NIHSS score by 4 points) and early neurologic improvement (ENI, decrease in NIHSS score by 4 points) at 1 week were determined. Follow-up imaging was obtained to evaluate intracranial hemorrhage (ICH).

RESULTS: Eleven patients were identified, 8 of whom were successfully revascularized. The mean age of all patients was 55 years with mean initial, 24-hour, and 1-week NIHSS scores of 14 ± 4, 11 ± 7, and 6 ± 5, respectively, with lower scores at 24 hours and 1 week (8 ± 5 and 4 ± 3, respectively) among patients successfully revascularized. Eight of the treated patients (72% of the total, 100% of those successfully revascularized) experienced ENI. No patient had END or ICH.

CONCLUSIONS: Endovascular treatment for acute ischemic stroke beyond 8 hours is feasible and may prevent END and promote ENI in patients fulfilling the criterion of a CDM. A prospective study is planned.

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