Effectiveness of endovascular treatment using a Merci clot Retriever device for wake-up ischemic strokes

Abstract

Background and Purpose: Wake-up ischemic stroke (WUIS) is generally not an indication for acute thrombolytic therapy due to the unverified precise time of onset. However, some of patients may have a good outcome if they undergo aggressive therapy including mechanical thrombectomy. We presented the number of WUIS matched to our indications for mechanical thrombectomy and referred the application possibility of mechanical thrombectomy to them. We also reported two patients of WUIS undergoing acute endovascular treatment after approval of the Merci clot Retriever at our hospital.Methods: In 158 patients hospitalized for cardiogenic embolism from January 2009 to December 2010 when the Merci clot Retriever was not yet approved at our hospital, we retrospectively investigated the frequency of wake-up ischemic strokes and analyzed radiological findings using diffusion-weighted image-Alberta Stroke Programme Computed Tomography Score (DWI-ASPECTS) in cases of intracranial large vessel occlusion.Results: Twenty-eight cases (17.7%) were WUIS. Of them, 5 were matched to our indication of mechanical thrombectomy. Both of the two patients undergoing acute endovascular thrombectomy with the Merci clot Retriever had a good outcome, modified Rankin Scale (mRS) 0 and 1, respectively.Conclusions: Mechanical thrombectomy using the Merci clot Retriever may be a good option for WUIS caused by large vessel occlusion on an adequate selection of patients.