Background The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs).
Methods Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion–perfusion mismatch. All patients underwent pre-transfemoral cerebral angiography and post-endovascular treatment. The patients were classified according to acute (onset-to-groin puncture time ≤6 hours) or subacute (onset-to-groin puncture time >6 hours) recanalization. Using propensity score analysis, recipients of acute and subacute recanalization underwent 1:1 matching.
Results Following 1:1 propensity score matching, 32 patients who underwent acute and 32 who underwent subacute intra-arterial thrombolysis were matched. There were no significant differences in National Institutes of Health Stroke Scale at discharge, modified Rankin scale (mRS), the proportion of patients with an mRS value of 0–2, mortality at discharge, intracerebral bleeding, postprocedural infarct extension, newly detected infarction, and hyperintense acute reperfusion marker on follow-up images between the acute and subacute recanalization groups.
Conclusions In selected patients with clinically unstable cerebral artery occlusions, a diffusion–perfusion mismatch and small CT lesions, subacute and acute recanalization has comparable safety and efficacy rates.
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Contributors SHL contributed to the study conception and design, data analysis, acquisition of clinical and imaging data, statistical analysis, manuscript drafting and revision. DCS contributed to the study conception and design, analysis and interpretation of the imaging and clinical data, manuscript drafting and revision, and study supervision. SHC contributed to the data analysis and manuscript revision. JJS contributed to the data analysis and manuscript revision. DHL contributed to the conception of the study and data analysis. JSK contributed to the conception of the study, data analysis and manuscript revision.
Funding This research received no specific grant from any funding agency in the public, commercial or not1for1profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Asan Medical Center IRB.
Provenance and peer review Not commissioned; externally peer reviewed.