title: Clinical predictors for favorable outcomes from endovascular recanalization in wake-up stroke.
abstract: OBJECTIVE
  Patients who have acute stroke symptoms present on awakening are ineligible for standard intravenous thrombolysis due to the unclear onset time of symptoms. Some of these wake-up stroke (WUS) patients may benefit from endovascular recanalization. This study aimed to evaluate clinical predictors of outcomes from endovascular recanalization in WUS patients.
  
  
  METHODS
  Forty-one WUS patients with internal carotid (ICA) or middle cerebral artery (MCA) occlusion treated with endovascular recanalization were reviewed. Regression analysis was performed to measure clinical predictors of outcomes from endovascular recanalization in WUS patients.
  
  
  RESULTS
  The mean initial NIHSS score was 16.41±4.96 (5-24). The mean symptom recognition-to-door time (SRDT) was 108.85±65.80 (19-230)min. Successful recanalization (TICI 2b-3) was achieved in 29 patients (70.7%). Thirty-four patients improved on NIHSS (amount 7.59±4.84, range; 1-17) at 7days after recanalization. At 90days after recanalization, a mRS of ≤2 was achieved in 19 patients (46.3%) and a mRS of ≤3 was achieved in 24 patients (58.5%). No symptomatic intracerebral hemorrhage occurred. Multivariate regression analysis identified SRDT (P=0.019), successful recanalization (P=0.005), and hypertension (P=0.013) were factors associated with an improvement of the NIHSS score. For a good functional outcome at 90days, SRDT (P=0.036) and initial NIHSS score (P=0.016) were found to be significant predictors.
  
  
  CONCLUSIONS
  The results of this study suggest that the SRDT is an independent predictor of both an improvement of NIHSS score and a good functional outcome in endovascular recanalization for WUS patients.
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea. Electronic address: aminoff@hanmail.net.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Diagnostic Radiology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Han Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Gi Yong
authors.initials: GY
authors.lastname: Cho
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Dae Soo
authors.initials: DS
authors.lastname: Jung
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurosurgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Jae Il
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurosurgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Jun Kyeung
authors.initials: JK
authors.lastname: Ko
authors.affiliation: Department of Neurology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Yip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002548:Cerebral Revascularization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D020521:Stroke / Q000175:diagnosis* / Q000601:surgery
keywords: Endovascular recanalization; Functional outcome; Symptom recognition-to-door time; Wake-up stroke