MR Imaging Selection for Endovascular Treatment in Acute Ischemic Stroke at 6 to 24 Hours

• Status: Recruiting
• Trial end date: 2024-05-01
• Target enrollment: 0
• Participant gender: All

Summary

The acute management of stroke patients requires a fast and efficient screening imaging modality. The primary modalities used to select patients for endovascular thrombectomy (EVT) are magnetic resonance imaging (MRI) and CT/MR perfusion. The investigators prospectively assessed MRI and CTP concordance/discordance and correlated the imaging on both with EVT treatment decisions and clinical outcomes to verify the validity of MRI (FVH-DWI mismatch) for the preoperative assessment of EVT in patients with an extended time window (6h to 24h).

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Tianjin Huanhu Hospital

Criteria

Inclusion Criteria:

• Patients over 18 years of old；

• Patients with acute anterior circulation ischemic stroke 6-24h after onset and NIHSS score ≥6 and RACE score ≥5 score at 6-24 hours of onset；

• No intracranial hemorrhage confirmed by cranial CT and CT ASPECTS score ≥ 6；

• The Modified Rankin Scale (mRS) before the onset of the disease was 0-2；

• All patients' legal representatives have signed the informed consent form；

• Pre-survival period 6 months or more.

Exclusion Criteria:

• 1. Active hemorrhage or preexisting tendency to hemorrhage

• CT shows hypointense areas exceeding 1/3 of the middle cerebral artery supply area, with significant midline structural displacement of cerebral edema

• Rapid neurological improvement, NIHSS score less than 6, or evidence of spontaneous revascularization

• Signs and symptoms typical of posterior circulation stroke, such as vertigo, nystagmus, choking, swallowing disorder, ataxia, and gaze to the affected side

• A stroke attack with epilepsy that prevents an accurate NIHSS score from being obtained.

• A platelet count of less than 100 x 10^9 /L

• Hereditary or acquired bleeding tendency, coagulation factor deficiency, recent anticoagulant medication (INR>3 or PPT more than 3 times normal)

• Presence of signs of cardiac, hepatic or renal failure

• Baseline blood glucose <50mg/dL (2.78mmol) or >400mg/dL (22.20mmol)

• Uncontrolled hypertension (SBP >185mmHg; DBP >110mmHg)

• Expected survival less than 90 days.

• Pregnancy.

• Chronic obstructive pulmonary disease, inflammation of the lungs, pleural effusion, ARDS, irregular breathing and other pulmonary diseases requiring emergency treatment.

• Patients with unstable vital signs (heart rate ≤ 50bpm or ≥ 120bpm, oxygen saturation less than ≤ 90%. R ≥ 30bpm or ≤ 10bpm.

• Patients who are unable to complete the 90-day follow-up

• A history of severe allergy to contrast media

• The presence of any other condition that is not suitable for endovascular treatment.