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Background: Clinical-diffusion mismatch (CDM) and perfusion-diffusion mismatch (PDM) are used to select patients for endovascular thrombectomy (EVT) in the late-window period. As CDM well reflects true penumbra, we hypothesized that patients with CDM and PDM would respond better to EVT than those with PDM only at the late-window period. Methods: Acute ischemic stroke patients who received EVT 6–24 h after stroke onset were included. PDM (perfusion-/diffusion-weighted image (DWI) lesion volume >1.8) was used to select candidates for EVT in this time-period in our center. CDM was defined according to the DAWN trial criteria. Response to EVT was compared between patients with and without CDM. Early neurological improvement (ENI) was defined as improvement >4 points on National Institutes of Health Stroke Scale (NIHSS) score 1 day after EVT. Multivariable analysis was performed to investigate independent factors associated with ENI. The correlation between DWI lesion volume and NIHSS score was investigated in those with and without CDM. Results: Among 94 patients enrolled, all patients had PDM and 44 (46.3%) had CDM. Forty-eight patients (51.1%) showed ENI. The prevalence of hypertension, initial NIHSS score, improvement in NIHSS score after EVT, and prevalence of ENI were greater in patients with CDM than those without. ENI was independently associated with onset-to-door time (odds ratio [95% confidence interval]: 0.998 [0.997–1.000]; p = 0.042), complete recanalization (23.912 [2.238–255.489]; p = 0.009), initial NIHSS score (1.180 [1.012–1.377]; p = 0.034), and the presence of CDM (5.160 [1.448–18.386]; p = 0.011). The correlation between DWI lesion volume and initial NIHSS score was strong in patients without CDM (r = 0.731) but only moderate in patients with CDM (r = 0.355). Conclusion: Patients with both CDM and PDM had a better response to late-window EVT than those with PDM only. [ABSTRACT FROM AUTHOR]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2006.00064.x Byline: Jee-Hyun Kwon (1), Jong S. Kim (1), Dong-Wha Kang (1), Kyun-Seop Bae (1), Sun U. Kwon (1) Keywords: Transcranial Doppler; temporal acoustic window failure; thickness of the temporal bone; inhomogeneity; bone mineral density; hypercholesterolemia Abstract: ABSTRACT Background and Purpose: Although transcranial Doppler (TCD) is useful for evaluation and treatment of ischemic stroke, temporal acoustic window failure (TAWF) limits its application. We performed this study to reveal whether initial brain CT of acute stroke patients predicted TAWF. Methods: We performed TCD in 92 acute ischemic stroke patients (57 males, aged 38-84 years) with brain CT scans. We measured the thickness (BTW) and evaluated the texture of the temporal bone in acoustic windows shown in the CT scan with the use of picture archiving and communication system. The bone mineral density (BMD) of the vertebral bodies, femurs, and whole body was also measured. Results: Doppler signals were adequately obtained in 121 (65.8%) of the 184 middle cerebral arteries (MCA) from both cerebral hemispheres. BTW and inhomogeneity of temporal bone, besides age, sex, and hypercholesterolemia, was strongly correlated with TAWF. BMD was not directly correlated with TAWF, but inhomogeneous temporal bone was correlated with lower BMD scores. If the brain CT scan showed thick (BTW [greater than or equal to] 2.7 mm) and inhomogeneous temporal bone, the possibility of TAWF was 93.5%, while if brain CT scan showed thin (BTW < 2.7 mm) and homogenous temporal bone, it was only 5.4%. Conclusions: The texture as well as the thickness of the temporal bone was the most important determinant of TAWF. When acute stroke patients had thin and homogeneous temporal bones in initial brain CT scan, TAWF was very rare, and loss of MCA signals on TCD specifcally indicated the absence of blood flow in MCA. Author Affiliation: (1)From the Department of Neurology, Ulsan University Hospital, University of Ulsan, College of Medicine (J-HK); Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine (JSK, D-WK, SUK); and Department of Clinical Pharmacology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (K-SB). Article History: Received April 7, 2006, and in revised form June 30, 2006. Accepted August 2, 2006. Article note: Address correspondence to Sun U. Kwon, MD, PhD, Department of Neurology, Asan Medical Center, Pungnapdong 388-1, Songpagu, Seoul, Korea. E-mail: sukwon@amc.seoul.kr.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients' healthcare use. This study evaluated changes in Korean stroke patients' health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR). Methods: We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region). Results: The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-CO-VID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%–2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, p = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods. Discussion/Conclusion: Korean stroke patients in a CO-VID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]