Search

National institutes of Health Stroke Scale (NIHSS) score and the presence of successful recanalization are crucial determinants of clinical outcome in patients with major artery occlusion. However, it is unknown whether successful recanalization rate after endovascular therapy (EVT) depends on NIHSS score.From our prospective EVT registry, data on patients with an occlusion at the internal carotid artery or middle cerebral artery were analyzed. Successful recanalization was judged as positive when reperfusion of the thrombolysis in cerebral infarction (TICI) scale ≥2b was observed. Successful recanalization rate was also evaluated based on the NIHSS score subgroups: 0-8, 9-16, 17-24, and24. Multivariate regression analysis was used to evaluate the impact of NIHSS score on successful recanalization.We studied 183 patients (age 76 [68-83], male 110 [60%], NIHSS score 19 [14-24]). One hundred and forty-six (80%) patients had the successful recanalization. Patients achieved the recanalization had lower NIHSS score as 18 (12-23), contrary those failed it had higher NIHSS score as 24 (20-27) (p .001). Successful recanalization rate was correlated to the NIHSS score grade; 100% in the NIHSS 0-8 group, 88% in 9-16, 81% in 17-24, and only 60% in24 (p .001). Multivariate regression analysis showed NIHSS score was an independent parameter of recanalization (odds ratio 0.905 [95%CI 0.837-0.979], p = .013).NIHSS score may serve as a predictor of successful recanalization. Recanalization is relatively easier in mild stroke than in those with severe stroke.

Background and Purpose: We investigated whether the signal change on fluid-attenuated inversion recovery (FLAIR) can serve as a tissue clock that predicts the clinical outcome after endovascular thrombectomy (EVT), independently of the onset-to-admission time. Methods: Consecutive patients with acute stroke treated with EVT between September 2014 and December 2018 were enrolled. Based on the parenchymal signal change on FLAIR, patients were classified into FLAIR-negative and FLAIR-positive groups. The clinical characteristics, imaging findings, EVT parameters, and the intracranial hemorrhage defined as Heidelberg Bleeding Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3 months was considered to represent a good outcome. Results: Of the 227 patients with EVT during the study period, 140 patients (62%) were classified into the FLAIR-negative group and 87 (38%) were classified into the FLAIR-positive group. In the FLAIR-negative group, the patients were older ( P =0.011), the onset-to-image time was shorter ( P P =0.006), and the rate of intravenous thrombolysis was higher ( P P =0.173), the frequency of both any-intracranial hemorrhage and Heidelberg Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive group ( P =0.004 and 0.011). At 3 months, the percentage of patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%) was significantly related to the FLAIR signal change ( P =0.047), while the onset-to-image time was not significant ( P =0.271). A multivariate regression analysis showed that a FLAIR-negative status was independently associated with a good outcome (odds ratio, 2.10 [95% CI, 1.02–4.31], P =0.044). Conclusions: A FLAIR-negative status may predict the clinical outcome more accurately than the onset-to-admission time, which may support the role of FLAIR as a tissue clock.

Purpose and Objective: There have been limited reports that focused on cognitive impairment in acute ischemic stroke after endovascular treatment. The aim of this study, therefore, was to investigate cognitive function in patient after endovascular treatment in acute phase and at 6 months follow-up. Method: In this prospective study, from December 2016 to November 2018, the patients who were diagnosed as ischemic stroke with occlusion of the internal carotid artery and of the middle cerebral artery and treated with endovascular treatment were enrolled. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA-J) test within 5 days of onset and at 6 months follow-up. We defined cognitive impairment as a score of Results: 150 patients were enrolled. MoCA-J was feasible in 69 patients (median 76 years; 49 female) (46%), in acute phase (Figure A). 63 patients (91%) had cognitive impairment and no significant differences were found in the naming and the abstraction domains between MoCA-J Conclusion: In acute phase of ischemic stroke after endovascular treatment, MoCA-J was feasible in about 45%, in which 91% had cognitive impairment. However, at 6 months follow-up, the median MoCA-J score was significantly higher and less number of patients had cognitive impairment. The present results suggest that cognition recovers with time after endovascular treatment in ischemic stroke.

Background: Two randomized controlled trials published in 2018 showed the effect of thrombectomy for acute ischemic stroke more than 6 hours after onset. It is reported that hyperintense lesions on fluid-attenuated inversion recovery (FLAIR positive) and susceptibility vessel sign (SVS) on T2*WI are associated with poor outcome (PO) in patients treated with rt-PA thrombolysis within 4.5 hours in acute ischemic stroke. However, it is not clear that FLAIR positive and SVS on T2*WI are associated with PO in patients treated with mechanical thrombectomy at 6 to 24 hours after the onset. Method: We enrolled 72 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke at 6 to 24 hours after the onset from April 2011 to June 2018. We retrospectively compared PO (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=38) with good outcome (GO, a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=34) and examined what was the predictor of PO. Result: FLAIR positive (41.2% vs 25.8%, P= 0.408) and SVS on T2*WI (32.4 vs 29.0%,P=0.852) were found similarly between both groups. Moreover, there was no significant difference between PO and GO groups in age (75.7 years old vs 69.4 years old, P= 0.062), stroke subtypes (P= 0.129), occlusion site (P= 0.682), DWI-ASPECTS (9 vs 8, P= 0.086), other risk factors. National Institutes of Health Stroke Scale (NIHSS) at admission was higher in PO group than GO group (17 vs 12, P = 0.047). The duration from onset to recanalization (O2R) was significantly longer in PO group than in GO group (765 min vs 631 min, P=0.043), and the median Thrombolysis In Cerebral Infarction (TICI) grade was significantly lower in PO group (P Conclusion: FLAIR positive and SVS on T2*WI did not associate with poor outcome in patients treated with thrombectomy at 6 to 24 hours.