MR Imaging Selection for Endovascular Treatment in Acute Ischemic Stroke at 6 to 24 Hours

The acute management of stroke patients requires a fast and efficient screening imaging modality. The primary modalities used to select patients for endovascular thrombectomy (EVT) are magnetic resonance imaging (MRI) and CT/MR perfusion. The investigators prospectively assessed MRI and CTP concordance/discordance and correlated the imaging on both with EVT treatment decisions and clinical outcomes to verify the validity of MRI (FVH-DWI mismatch) for the preoperative assessment of EVT in patients with an extended time window (6h to 24h).

Inclusion Criteria:Patients over 18 years of old；Patients with acute anterior circulation ischemic stroke 6-24h after onset and NIHSS score ≥6 and RACE score ≥5 score at 6-24 hours of onset；No intracranial hemorrhage confirmed by cranial CT and CT ASPECTS score ≥ 6；The Modified Rankin Scale (mRS) before the onset of the disease was 0-2；All patients' legal representatives have signed the informed consent form；Pre-survival period 6 months or more.Exclusion Criteria:1. Active hemorrhage or preexisting tendency to hemorrhageCT shows hypointense areas exceeding 1/3 of the middle cerebral artery supply area, with significant midline structural displacement of cerebral edemaRapid neurological improvement, NIHSS score less than 6, or evidence of spontaneous revascularizationSigns and symptoms typical of posterior circulation stroke, such as vertigo, nystagmus, choking, swallowing disorder, ataxia, and gaze to the affected sideA stroke attack with epilepsy that prevents an accurate NIHSS score from being obtained.A platelet count of less than 100 x 10^9 /LHereditary or acquired bleeding tendency, coagulation factor deficiency, recent anticoagulant medication (INR>3 or PPT more than 3 times normal)Presence of signs of cardiac, hepatic or renal failureBaseline blood glucose <50mg/dL (2.78mmol) or >400mg/dL (22.20mmol)Uncontrolled hypertension (SBP >185mmHg; DBP >110mmHg)Expected survival less than 90 days.Pregnancy.Chronic obstructive pulmonary disease, inflammation of the lungs, pleural effusion, ARDS, irregular breathing and other pulmonary diseases requiring emergency treatment.Patients with unstable vital signs (heart rate ≤ 50bpm or ≥ 120bpm, oxygen saturation less than ≤ 90%. R ≥ 30bpm or ≤ 10bpm.Patients who are unable to complete the 90-day follow-upA history of severe allergy to contrast mediaThe presence of any other condition that is not suitable for endovascular treatment.