Acute Moderate Hemodynamic Stroke Secondary to Large Vessel Stenosis: A Case Series Exploring Imaging Characteristics and Endovascular Treatment Outcomes.

Abstract

Background: This study aimed to characterize the imaging features and the outcomes of endovascular treatment (EVT) in patients with moderate hemodynamic stroke due to large vessel stenosis.

Methods: Data from patients with moderate hemodynamic stroke due to large vessel stenosis who underwent EVT at a single center between January 2021 and June 2024 were retrospectively analyzed. Hemodynamic stroke was defined as infarction in the watershed area on diffusion-weighted imaging and hypoperfusion on perfusion-weighted imaging. Demographics, National Institutes of Health Stroke Scale (NIHSS), imaging findings, cerebral circulation time (CCT; the interval from arterial origin visualization to completion of the intracranial arterial phase), and EVT details were collected. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at 90-day post-stroke.

Results: Among 313 patients treated with EVT, 14 (4.4%) were diagnosed with moderate hemodynamic stroke secondary to large vessel stenosis. The mean age was 64.6±11.8 years, and the median NIHSS score was 9 (range, 6-12). Stenosis was predominantly located at the origin of the vertebral artery in 12 cases and at the origin of the internal carotid artery in 2 cases. All patients underwent stent angioplasty, leading to a significant reduction in median CCT from 3.0 s preoperatively to 1.43 s postoperatively (P=0.00001). At 90-day post-stroke, 78.6% of patients (11/14) achieved a functional independence.

Conclusion: Moderate hemodynamic stroke caused by large vessel stenosis was relatively rare but could be safely and effectively treated with EVT.