Retrospective evaluation of the efficacy of mechanical thrombectomy in acute ischemic wake-up strokes

The symptom duration is the one of the most important prognostic factors in acute ischemic stoke. Prolongation of the symptom duration may entail, irreversible neuron damage. Therefore, determining symptom onset time is a very important step in the decision of mechanical thrombectomy. However, the duration of symptoms is not known in ischemic wake-up strokes. That is why, management of these cases is harder compared to patients with known onset strokes. In the DAWN and DEFUSE-3 studies, mechanical thrombectomy has been proven to be effective for up to 16-24 hours in patients selected with advanced imaging methods. In this way, mechanical thrombectomy was started to be performed more frequently in patients with unknown sypmtom onset. In this thesis, we aimed to evaluate the feasibility of mechanical thrombectomy in patients with acute ischemic wake-up strokes. Twenty-two acute ischemic wake-up stroke cases treated with mechanical thrombectomy in Bursa Uludağ University Medical Faculty Hospital between January 2012 and February 2020 were evaluated retrospectively. Demographic data and comorbid diseases of the patients were recorded. After mechanical thrombectomy, recanalization of the occluded vessel was evaluated with Thrombolysis in Cerebral Infarction (TICI) scale. TICI≥2b recanalization was considered successful. In our study, TICI≥2b recanalization was achieved at the rate of 86.36% (19/22). The functional outcome was evaluated on the 90th day with the modified Rankin Scale (mRS). The targeted clinical outcome was determined as functional independence (mRS≤2). Functional independence was achieved at the rate of 36.36% (8/22). Symptomatic intracranial hemorrhage was observed in 2 (9.09%) cases. The results we obtained in our thesis study suggest that high functional independence rates can be achieved with mechanical thrombectomy in wake-up strokes. Similarly, our low complication rates support the safety of mechanical thrombectomy in this patient group.