title: Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours.
abstract: OBJECTIVE
  Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW).
  
  
  METHODS
  A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment.
  
  
  RESULTS
  We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38%, n=78) and (2) patients with witnessed onset beyond 8 h (62%, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43% vs. 50%, p=0.3), parenchymal hematoma (9% vs. 5.5%, p=0.3), and final infarct volume (75.2 vs. 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95% CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95% CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes.
  
  
  CONCLUSIONS
  Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Aghaebrahim
authors.affiliation: Neuroradiology Division, Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Ashutosh P
authors.initials: AP
authors.lastname: Jadhav
authors.affiliation: Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Mouhammad
authors.initials: M
authors.lastname: Jumaa
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Xabi
authors.initials: X
authors.lastname: Urra
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Edilberto
authors.initials: E
authors.lastname: Amorim
authors.affiliation: Neuroradiology Division, Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Guangming
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Dan-Victor
authors.initials: DV
authors.lastname: Giurgiutiu
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Horev
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Hammer
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wechsler
authors.affiliation: Neuroradiology Division, Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods* / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods / Q000639:trends; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke; angiography; beyond 8 hours; brain infarction; endovascular treatment; interventional neuroradiology; wake up stroke