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.