Clinical predictors for favorable outcomes from endovascular recanalization in wake-up stroke

Sang Min Sung; Tae Hong Lee; Han Jin Cho; Gi Yong Cho; Dae Soo Jung; Jae Il Lee; Jun Kyeung Ko; Samuel Yip

doi:10.1016/j.jocn.2017.02.021

Clinical predictors for favorable outcomes from endovascular recanalization in wake-up stroke

J Clin Neurosci. 2017 Jul:41:66-70. doi: 10.1016/j.jocn.2017.02.021. Epub 2017 Mar 2.

Authors

Sang Min Sung¹, Tae Hong Lee², Han Jin Cho³, Gi Yong Cho³, Dae Soo Jung³, Jae Il Lee⁴, Jun Kyeung Ko⁴, Samuel Yip⁵

Affiliations

¹ Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea. Electronic address: aminoff@hanmail.net.
² Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Diagnostic Radiology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
³ Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
⁴ Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurosurgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
⁵ Department of Neurology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.

PMID: 28262403
DOI: 10.1016/j.jocn.2017.02.021

Abstract

Background and purpose: Patients who have acute stroke symptoms present on awakening are ineligible for standard intravenous thrombolysis due to the unclear onset time of symptoms. Some of these wake-up stroke (WUS) patients may benefit from endovascular recanalization. This study aimed to evaluate clinical predictors of outcomes from endovascular recanalization in WUS patients.

Methods: Forty-one WUS patients with internal carotid (ICA) or middle cerebral artery (MCA) occlusion treated with endovascular recanalization were reviewed. Regression analysis was performed to measure clinical predictors of outcomes from endovascular recanalization in WUS patients.

Results: The mean initial NIHSS score was 16.41±4.96 (5-24). The mean symptom recognition-to-door time (SRDT) was 108.85±65.80 (19-230)min. Successful recanalization (TICI 2b-3) was achieved in 29 patients (70.7%). Thirty-four patients improved on NIHSS (amount 7.59±4.84, range; 1-17) at 7days after recanalization. At 90days after recanalization, a mRS of ≤2 was achieved in 19 patients (46.3%) and a mRS of ≤3 was achieved in 24 patients (58.5%). No symptomatic intracerebral hemorrhage occurred. Multivariate regression analysis identified SRDT (P=0.019), successful recanalization (P=0.005), and hypertension (P=0.013) were factors associated with an improvement of the NIHSS score. For a good functional outcome at 90days, SRDT (P=0.036) and initial NIHSS score (P=0.016) were found to be significant predictors.

Conclusions: The results of this study suggest that the SRDT is an independent predictor of both an improvement of NIHSS score and a good functional outcome in endovascular recanalization for WUS patients.

Keywords: Endovascular recanalization; Functional outcome; Symptom recognition-to-door time; Wake-up stroke.

MeSH terms

Aged
Aged, 80 and over
Cerebral Hemorrhage / diagnosis
Cerebral Hemorrhage / epidemiology*
Cerebral Hemorrhage / etiology
Cerebral Revascularization / adverse effects*
Female
Humans
Male
Middle Aged
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology*
Stroke / diagnosis*
Stroke / surgery