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. 2025 Apr 15;17(4):3131-3141.
doi: 10.62347/GLEJ7849. eCollection 2025.

Diffusion-weighted imaging and the Alberta Stroke Program Early CT Score (DWI-ASPECTS)-guided intra-arterial thrombectomy beyond 6 hours: feasibility, substantial efficacy, and acceptable safety

Guodong Xu  1 , Xiaoli Dong  1 , Xiaohui Liang  1 , Liang Ma  1
Affiliations

Diffusion-weighted imaging and the Alberta Stroke Program Early CT Score (DWI-ASPECTS)-guided intra-arterial thrombectomy beyond 6 hours: feasibility, substantial efficacy, and acceptable safety

Guodong Xu et al. Am J Transl Res. .

Abstract

Objectives: To assess the safety and efficacy of intra-arterial thrombectomy for patients with acute ischemic stroke due to large vessel occlusion (LVO) treated beyond the traditional 6-hour window, using diffusion-weighted imaging and the Alberta Stroke Program Early CT Score (DWI-ASPECTS) for patient selection.

Methods: A retrospective study was conducted at Hebei General Hospital, involving 263 acute stroke patients treated between November 2022 and August 2024. Patients were categorized into two cohorts based on treatment timing: within 6 hours (n = 156) and beyond 6 hours (n = 107). Outcomes included the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] scale), coagulation parameters, and adverse event rates as safety measures.

Results: Demographics and baseline conditions were comparable across groups. The beyond-6-hour group showed prolonged time from symptom onset to intervention, with slightly higher mRS and NIHSS scores at discharge and 90 days, indicating poorer functional and neurological outcomes (P < 0.05 for both). The beyond-6-hour group had a significantly lower vascular recanalization rate (mTICI ≥ 2b: 84.11%) compared to the within-6-hour group (93.59%, P = 0.013). However, the overall safety profile was similar, with no significant differences in adverse event rates.

Conclusion: Intra-arterial thrombectomy beyond the standard 6-hour window was feasible, showing substantial efficacy and an acceptable safety profile when guided by DWI-ASPECTS.

Keywords: Acute ischemic stroke; DWI-ASPECTS; large vessel occlusion; thrombectomy; treatment window; vascular recanalization.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Comparison of various time points in treatment between the two groups. A: OTI (min); B: OTP (min); C: PTP (min); D: OTR (min); E: Length of Hospital Stay. OTI: Time from symptom onset to imaging; OTP: Time from symptom onset to femoral artery puncture; PTP: Time from femoral artery puncture to reperfusion; OTR: Time from symptom onset to reperfusion. Ns: P > 0.05; **: P < 0.01; ***: P < 0.001.
Figure 2
Figure 2
Comparison of mRS scores between the two groups. A: At Admission; B: At Discharge; C: At 90 Days. Ns: P > 0.05; *: P < 0.05.
Figure 3
Figure 3
Comparison of NIHSS scores between the two groups. A: At Admission; B: At Discharge; C: At 90 Days. Ns: P > 0.05; *: P < 0.05.
See this image and copyright information in PMC

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