Approximately 16% to 28% of acute ischemic stroke patients have symptoms on awakening. Because of unclear time of symptom onset, these patients are ineligible for standard intravenous thrombolysis. Some of these patients may be benefit from emergent endovascular recanalization with stenting. The purpose of this study was to evaluate the feasibility and safety of emergent endovascular recanalization for wake-up stroke (WUS).Methods
We reviewed 10 patients with WUS and an occlusion in carotid and middle cerebral artery who were treated with stenting. We analyzed clinical and angiographic outcomes. Recanalization was evaluated by the Thrombolysis in Cerebral Infarction score. Clinical outcome was assessed at 90 days by the modified Rankin Scale.Results
The median NIHSS score on admission was 19 points (range 8–24). The median time from stroke symptom recognition to arrival at emergency department was 144 min (range 57–230 min). The median time from stroke symptom recognition to recanalization was 312 min (range 227–344 min). The median time from last seen normal to recanalization was 11 h 23 min (range 495–830 min). Occlusion sites were supraclinoid ICA in 2 (all: left), proximal ICA in 3 (left: 2, right: 1) and M1 of MCA in 5 patients (left: 2, right: 3). Successful recanalization was achieved in all patients. A small subarachnoid haemorrhage occurred in 1 patient during intervention. No symptomatic ICH occurred in any patients. Neurologic improvements in the NIHSS score (median 9, range 4–17) at 7 days after stenting achieved in 7 patients. At 90 days, an mRS of ≤2 was achieved in 2 patients (20%). One patient died within hospital stay due to sepsis.Conclusion
Emergent stenting can be feasible and possibly safe for achieving successful recanalization and improving on the NIHSS in patients with WUS. However, clinical outcome was still not satisfactory.Disclosures
S. Sung: None. T. Lee: None.