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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates


Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention

Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset

P. Bücke, M. Aguilar Pérez, V. Hellstern, M. AlMatter, H. Bäzner and H. Henkes
American Journal of Neuroradiology February 2018, DOI: https://doi.org/10.3174/ajnr.A5540
P. Bücke
aFrom the Psychiatric University Hospital Zurich (P.B.), University of Zurich, Zurich, Switzerland
bNeurological Clinic (P.B., H.B.)
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M. Aguilar Pérez
cNeuroradiological Clinic (M.A.P., V.H., M.A., H.H.), Klinikum Stuttgart, Stuttgart, Germany
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V. Hellstern
cNeuroradiological Clinic (M.A.P., V.H., M.A., H.H.), Klinikum Stuttgart, Stuttgart, Germany
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M. AlMatter
cNeuroradiological Clinic (M.A.P., V.H., M.A., H.H.), Klinikum Stuttgart, Stuttgart, Germany
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H. Bäzner
bNeurological Clinic (P.B., H.B.)
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H. Henkes
cNeuroradiological Clinic (M.A.P., V.H., M.A., H.H.), Klinikum Stuttgart, Stuttgart, Germany
dMedical Faculty (H.H.), University Duisburg-Essen, Essen, Germany.
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Article Figures & Data

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    Fig 1.

    Flowchart depicting patient selection according to predefined inclusion and exclusion criteria. IVT indicates intravenous thrombolysis.

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    Fig 2.

    Distribution of mRS scores at 90 days.

Tables

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    Table 1:

    Primary and secondary outcome parameters

    Control Group (n = 780)WUS (n = 128)DUS (n = 165)P ValueaP Valueb
    mRS 0–2 at 3 mo (No.) (%)299 (38.3)46 (35.9)45 (27.3).025(A) .625
    (B) .007
    (C) .127
    In-hospital mortality (No.) (%)145 (18.9)16 (12.6)38 (23.3).067NA
    All-cause mortality at 3 mo (No.) (%)207 (26.5)29 (22.7)52 (31.5).224NA
    sICH (No.) (%)42 (5.5)3 (2.4)10 (6.3).292NA
    • Note:—sICH indicates symptomatic intracranial hemorrhage.

    • ↵a P value for group comparison.

    • ↵b P value for head-to-head comparison, calculated when the P value for the group comparison was <.05: (A), control group vs WUS; (B), control group vs DUS; (C), WUS vs DUS.

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    Table 2:

    Subgroup analysis—patient selection via imaging modalities

    Control Group (n = 780)WUS[advanced] (n = 68)DUS[advanced] (n = 63)P ValueaP Valueb
    A) CTP or MRI [advanced]
        mRS 0–2 (3 mo) (No.) (%)299 (38.3)32 (47.1)23 (36.5).344NA
        In-hospital mortality (No.) (%)145 (18.9)5 (7.5)8 (12.7).031(A) 0.019
    (B) .309
    (C) .388
        All-cause mortality (3 mo) (No.) (%)207 (26.5)11 (16.2)13 (20.6).120NA
        sICH (No.) (%)42 (5.5)1 (1.5)2 (3.3).380NA
    Control Group (n = 780)WUS[mri] (n = 47)DUS[mri] (n = 52)
    B) MRI [mri]
        mRS 0–2 (3 mo) (No.) (%)299 (38.3)24 (51.1)20 (38.5).216NA
        In-hospital mortality (No.) (%)145 (18.9)2 (4.3)8 (15.4).024(A) .009
    (B) .713
    (C) .204
        All-cause mortality (3 mo) (No.) (%)207 (26.5)6 (12.8)12 (23.1).093NA
        sICH (No.) (%)42 (5.5)1 (2.2)2 (4.0).808NA
    Control [mri] (n = 170)WUS[mri] (n = 47)DUS[mri] (n = 52)
    C) MRI compared with selected controls [mri]
        mRS 0–2 (3 mo) (No.) (%)83 (48.8)24 (51.1)20 (38.5).357NA
        In-hospital mortality (No.) (%)19 (11.5)2 (4.3)8 (15.4).211NA
        All-cause mortality (3 mo) (No.) (%)34 (20.0)6 (12.8)12 (23.1).385NA
        sICH (No.) (%)5 (3.0)1 (2.2)2 (4.0).875NA
    • Note:—sICH indicates symptomatic intracranial hemorrhage; NA, not applicable.

    • ↵a P value for group comparison.

    • ↵b P value for head-to-head comparison, calculated when the P value for the group comparison was <.05: (A), control group vs WUS; (B), control group vs DUS; (C), WUS vs DUS.

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    Table 3:

    Effect of advanced imaging on outcome and safety

    WUS[advanced] (n = 68)Non-WUS[advanced] (n = 60)OR (95% CI), P Value
    A) WUS treated after CTP or MRI [advanced] compared with the remaining WUS [non-advanced]
        mRS 0–2 (3 mo) (No.) (%)32 (47.1)14 (23.3)2.92 (1.32–6.45), .006
        In-hospital mortality (No.) (%)5 (7.5)11 (18.3)0.36 (0.11–1.12), .106
        All-cause mortality (3 mo) (No.) (%)11 (16.2)18 (30.0)0.45 (0.19–1.07), .090
        sICH (No.) (%)1 (1.5)2 (3.4)0.43 (0.04–4.95), .599
    DUS[advanced] (n = 63)Non-DUS[advanced] (n = 102)
    B) DUS treated after CTP and MRI [advanced] compared with the remaining WUS [non-advanced]
        mRS 0–2 (3 mo) (No.) (%)23 (36.1)22 (21.6)2.09 (1.03–4.25), .048
        In-hospital mortality (No.) (%)8 (12.7)30 (30.0)0.34 (0.14–0.82), .013
        All-cause mortality (3 mo) (No.) (%)13 (20.6)39 (38.2)0.42 (0.20–0.88), .025
        sICH (No.) (%)2 (3.3)8 (8.1)0.39 (0.08–1.90), .320
    WUS[mri] (n = 47)Non-WUS[mri] (n = 81)
    C) WUS treated after MRI [mri] compared with the remaining WUS [non-mri]
        mRS 0–2 (3 mo) (No.) (%)24 (51.1)22 (27.2)2.80 (1.28–6.10), .008
        In-hospital mortality (No.) (%)2 (4.3)14 (17.3)0.22 (0.05–1.04), .049
        All-cause mortality (3 mo) (No.) (%)6 (12.8)23 (28.4)0.37 (0.14–1.01), .050
        sICH (No.) (%)1 (2.2)2 (2.6)0.84 (0.07–9.68), 1.000
    DUS[mri] (n = 52)Non-DUS[mri] (n = 113)
    D) DUS treated after MRI [mri] compared with the remaining DUS [non-mri]
        mRS 0–2 (3 mo) (No.) (%)20 (38.5)25 (22.1)2.20 (1.06–4.55), .038
        In-hospital mortality (No.) (%)8 (15.4)30 (27.0)0.49 (0.21–1.17), .115
        All-cause mortality (3 mo) (No.) (%)12 (23.1)40 (35.4)0.55 (0.27–1.17), .149
        sICH (No.) (%)2 (4.0)8 (7.3)0.53 (0.11–2.62), .726
    • Note:—sICH indicates symptomatic intracranial hemorrhage.

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Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset
P. Bücke, M. Aguilar Pérez, V. Hellstern, M. AlMatter, H. Bäzner, H. Henkes
American Journal of Neuroradiology Feb 2018, DOI: 10.3174/ajnr.A5540
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Cite this article
P. Bücke, M. Aguilar Pérez, V. Hellstern, M. AlMatter, H. Bäzner, H. Henkes
Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset
American Journal of Neuroradiology Feb 2018, DOI: 10.3174/ajnr.A5540

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