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(Stroke. 2009;40:e504.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Dai et al

Caspar Brekenfeld, MD Gerhard Schroth, MD, PhD

Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne, Bern, Switzerland

Marcel Arnold, MD, PhD

Department of Neurology, Inselspital, University of Bern, Bern, Switzerland

Dai-Do Do, MD, PhD

Department of Angiology, Inselspital, University of Bern, Bern, Switzerland

Jan Gralla, MD, MSc

Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We deeply appreciate the interest of Dr Dai and his colleagues in our study. Certainly, differences in stroke etiology exist between Asian and European populations. The higher incidence of intracranial vessel stenosis in the Asian population implicates that stent placement for acute vessel recanalization might be the treatment of choice for acute stroke in these patients. However, this assumption has to be proofed by future studies. Additionally, it will be a challenge to assess the underlying cause of a cerebral artery occlusion in the acute situation, which might be possible in the future considering recent developments in high-field MRI of acute stroke.

Dr Dai and colleagues mentioned that an open vessel might not always be a good thing and that strokes caused by cardioembolism may have a higher risk of hemorrhagic transformation. These concerns appear to be unsubstantiated: retrospective analysis of 2066 stroke patients confirmed that recanalization is strongly associated with good outcome and decreased mortality after acute ischemic stroke.¹ Moreover, in 294 patients treated at our institution, stroke etiology was no predictor of symptomatic intracranial hemorrhage (sICH), and in contradiction to Dr Dai’s concerns, failed recanalization was associated with sICH.²

Of the twelve patients reported in the present study who were treated by stent placement,³ six patients had local thrombosis of an intracranial artery and six patients had embolic strokes. Mortality was 33.3% for both groups and good outcome (mRS 0 to 2) was achieved in 2/6 patients with embolic stroke and in 1/6 patients with local intracranial . . . [Full Text of this Article]