title: Endovascular therapy of wake-up strokes in the modern era of stent retriever thrombectomy.
abstract: BACKGROUND
  Endovascular treatment of wake-up strokes (WUS) has been previously described, mostly with the use of pharmacological thrombolysis or first generation thrombectomy devices.
  
  
  OBJECTIVE
  To describe outcomes of WUS treated with modern endovascular therapy since the Food and Drug Administration approval of stent retrievers, and to identify predictors of good clinical outcome in this population of stroke patients.
  
  
  METHODS
  We performed a multicenter retrospective analysis of consecutive patients with WUS who underwent thrombectomy with stent retrievers Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire FR (Covidien, Irvine, California, USA), or primary aspiration thrombectomy. We correlated favorable clinical outcomes with demographic, clinical, and technical characteristics.
  
  
  RESULTS
  52 patients were included in this study; 46 (88%) cases were treated with stent retrievers and 6 (12%) were treated with primary aspiration thrombectomy alone. Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b/3) was achieved in 36 (69%) patients. Favorable clinical outcome at 3 months, defined as a modified Rankin Scale score of 0-2, was achieved in 25 (48%) patients. Duration of intervention <30 min and its success, defined as TICI 2b/3 recanalization, were strong predictors of favorable clinical outcome at 90 days (p<0.001 and p<0.0001, respectively).
  
  
  CONCLUSIONS
  Our study indicates that endovascular treatment of WUS with stent retrievers and aspiration thrombectomy is safe and effective.
authors: Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA.
authors: Maxim
authors: M
authors: Mokin
authors: Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA.
authors: Peter
authors: P
authors: Kan
authors: Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA.
authors: Sananthan
authors: S
authors: Sivakanthan
authors: Capital Health, Trenton, New Jersey, USA.
authors: Erol
authors: E
authors: Veznedaroglu
authors: Capital Health, Trenton, New Jersey, USA.
authors: Mandy J
authors: MJ
authors: Binning
authors: Capital Health, Trenton, New Jersey, USA.
authors: Kenneth M
authors: KM
authors: Liebman
authors: Capital Health, Trenton, New Jersey, USA.
authors: Pinakin R
authors: PR
authors: Jethwa
authors: Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Raymond D
authors: RD
authors: Turner
authors: Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Aquilla S
authors: AS
authors: Turk
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Sabareesh K
authors: SK
authors: Natarajan
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Elad I
authors: EI
authors: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D014851:Wakefulness