The significance and characteristics of the patients with Ribbon-like signal hyperintensity after acute ischemic stroke

Background We discovered a novel finding of ribbon-like signal hyperintensity of the cerebral cortical gyri, named the ribbon sign, after reperfusion therapy. Herein, we report the significance and clinical characteristics of ribbon signs. Methods Data from consecutive patients with acute ischemic stroke and anterior large-vessel occlusion were prospectively extracted from the Tokushima University Hospital Stroke Registry between January 2011 and March 2020. Diffusion-weighted imaging (DWI) was retrospectively assessed in patients with acute ischemic stroke with large-vessel occlusion, with or without treatment. Results A total of 140 patients (78 males, Average age: 75.7 years) were enrolled in the study. The mean DWI-Alberta Stroke Program Early Computed Tomography Score (DWI- ASPECTS) was 7.0. Among the patients, 113 (80.7%) underwent reperfusion therapy and 95 (67.9%) had unfavorable outcomes. Eighty-one (57.9%) patients underwent successful recanalization. The ribbon sign was more common in patients with successful recanalization than in the patients with unsuccessful recanalization (53.1% vs. 8.5%, respectively; p <0.01). Conclusion Our study is the first to report that the ribbon sign is a specific finding after successful recanalization in patients with acute ischemic stroke. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by a Grant-in-Aid for Young Scientists (JSPS KAKENHI Grant Number 20K17933). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Tokushima University Hospital Ethics Committee. Written informed consent was obtained from the patients. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Raw data were generated at Tokushima University Hospital. Derived data supporting the findings of this study are available from the corresponding author [TM] on request. * DWI : Diffusion-weighted imaging DWI-ASPECTS : DWI-Alberta Stroke Program Early Computed Tomography Score IVT : intravenous thrombolysis EVT : endovascular treatment AIS : acute ischemic stroke LVO : large-vessel occlusion MRI : magnetic resonance imaging ICA : internal carotid artery MCA : middle cerebral artery NIHSS : National Institutes of Health Stroke Scale score SD : standard deviation mRS : modified Rankin Scale tPA : tissue-type plasminogen activator