Correlation of Circadian and Homeostatic Changes in the Sleep-Wake Pattern with Quality of Life in Chronic Stroke Patients

Introduction: Acute revascularization improves outcomes after large vessel acute ischemic strokes (AIS). We now describe the angiographic and clinical results of the use of a novel mechanical clot retriever (Solitaire device). Methods: Patients presenting with AIS were treated at the Geneva University Hospital. We work under a bridging stroke protocol where patients arriving until 4h30min start IV thrombolysis and, at 30 minutes, if no clinical improvement or transcranial Doppler initial recanalization (TIBI 3), a bridge to IA therapy is performed. Patients with any contraindication to IV rtPA or arriving later than 4h30min are treated direct with IA therapy. Results: From March to December 2009, twenty-five cases of acute stroke due to occlusion of the intracranial internal carotid (n=5) or middle cerebral (n=20) arteries were treated using the Solitaire AB or FR device as the first line treatment modality. Fifteen patients were men (60%). The mean age was 66,3 years (range, 20-85) and the mean baseline NIHSS score was 18,7 (range, 8-30). Twelve (48%) patients had IV treatment before endovascular procedure and thirteen (52%) patients went directly to intra-arterial mechanical therapy. The mean time from the onset of symptoms to treatment was 250 minutes. The mean time from first angiogram to reperfusion (TICI >2) was 42 minutes. A final satisfactory angiographic result (TICI 2b and 3) was obtained in all patients. In twenty-two patients, the device was used exclusively with a mean of 2,3 attempts to get final result. The overall hemorrhagic complication rate was 20% but only 12% symptomatic. One subarachnoid hemorrhage with no clinical significance was also observed. One patient developed malignant edema in spite of an angiographic result of TICI 2b. Good outcomes at 90 days (mRS 0.036). Conclusion: Mechanical thrombectomy with the Solitaire device appears to be safe and effective and may result in faster recanalization.