Neurointervention.  2023 Nov;18(3):159-165. 10.5469/neuroint.2023.00353.

Endovascular Reperfusion Therapy in Minor Stroke with Neurologic Deterioration beyond 24 Hours from Onset

• Lee MA
• Hwang BW
• Ha SW
• Kim JH
• Kim HS
• Ahn SH

• KMID: 2547277
• DOI: http://doi.org/10.5469/neuroint.2023.00353

Abstract

Purpose
Patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) and large vessel occlusion (LVO) often experience neurological deterioration >24 hours after onset. However, the efficacy of endovascular reperfusion therapy in these patients remains unclear. The aim of this study was to determine the efficacy and safety of reperfusion therapy in patients with minor stroke and neurological deterioration >24 hours after onset.
Materials and Methods
Data were retrospectively reviewed from patients between January 2019 and April 2022 who met the following criteria: (1) minor stroke and small definitive ischemic lesions at initial visit, (2) onset to neurological deterioration >24 hours, (3) cortical signs, Alberta Stroke Program Early computed tomography (CT) Score >6 points, and large artery occlusion confirmed by CT angiography at neurological deterioration. Efficacy and safety outcomes were based on final thrombolysis in cerebral infarction (TICI), incidence of symptomatic intracranial hemorrhage (ICH), and mortality. Outcomes were assessed using the modified Rankin Scale (mRS) at 3 months. Good outcome was defined as a mRS of 0, 1, or 2.
Results
Data from 26 patients (38.4% female, mean age 75.8 years) were analyzed; 18 (69.2%) had a good outcome. A final TICI of 2b or 3 was observed in 24 (92.3%) patients. No other adverse events, including dissection, vasospasm or distal embolization, were observed during the procedures. Hemorrhagic events occurred in 8 patients after the procedure; however, there were no symptomatic ICHs. Good prognostic factors were younger age (P=0.062) and carotid stenting (P=0.025).
Conclusion
Endovascular reperfusion therapy performed in selected patients with minor stroke, LVO, and neurological deterioration >24 hours after stroke onset demonstrated favorable outcomes and safety.

Keyword

Acute ischemic stroke; Minor stroke; Disease progression; Thrombectomy; Angioplasty

Figure

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  Fig. 1. Endovascular recanalization therapy and brain diffusion-weighted imaging before and after 24 hours of the procedure. (A) In digital subtraction angiography performed 83.9 hours after occurrence, left MCA proximal site occlusion and decreased filling on distal flow. (B) After 1 thrombectomy, a partially recanalized, but left MCA mid portion diffuse severe atherosclerotic stenosis and decreased distal flow were detected. (C) Stent insertion was carried out, full recanalization and TICI grade 3 of distal flow were identified. (D) Diffusion restriction of left periventricular area and temporo-parietal lobe at initial. (E) After 24 hours of the procedure, there was no significant difference compared with the previous ischemic lesion. MCA, middle cerebral artery; TICI, thrombolysis in cerebral infarction.

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