Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤\u20095 can benefit from endovascular treatment: a single-center experience and literature review

Abstract

PurposeThe recommendation strength of the guidelines for mechanical thrombectomy among patients with large pre-treatment core infarct is weak. We evaluated the safety and outcome of endovascular treatment for acute ischemic stroke with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤\u20095.MethodsData on acute ischemic stroke patients with DWI-ASPECTS ≤\u20095 who underwent endovascular treatment within 6\xa0h, or presented an arterial spin labeling-DWI (ASL-DWI) mismatch within 12\xa0h, at our center were retrospectively collected. We report the clinical characteristics and outcome of every patient, and review the relevant literature.ResultsAmong the 19 patients who were enrolled, all experienced successful reperfusion, and 10 achieved a favorable outcome (modified Rankin scale (mRS) ≤\u20092). Two patients presented with symptomatic intracranial hemorrhage (sICH); both of them had a poor outcome (mRS >\u20092).ConclusionAcute ischemic stroke patients with large DWI lesions caused by large vessel occlusion can achieve a favorable clinical outcome with endovascular treatment if recanalization is performed within 6\xa0h, or after 6\xa0h in case of an ASL-DWI mismatch.