Neurological Sciences

, Volume 39, Issue 10, pp 1705–1712 | Cite as

Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy

  • Paola CarusoEmail author
  • Marcello Naccarato
  • Giovanni Furlanis
  • Miloš Ajčević
  • Lara Stragapede
  • Mariana Ridolfi
  • Paola Polverino
  • Maja Ukmar
  • Paolo Manganotti
Original Article



Ischemic stroke is a neuroemergency condition highly treatable with thrombolysis and thrombectomy. Recently, observational studies have brought insights into clinical and imaging characteristics of wake-up stroke, which interested up to 25% of ischemic stroke patients. In clinical practice, wake-up strokes are usually not considered for reperfusion therapy. The aim of this study was to investigate the use CT perfusion imaging in patients with wake-up stroke and to assess the effect of neuroimaging information provided by CT perfusion maps on the efficacy and safety of thrombolysis and thrombectomy.

Patients and method

We studied 22 wake-up stroke (WUS) patients (13F/9M mean age) who underwent reperfusion therapy after the eligibility assessed by the CT perfusion imaging (< 50% core-to-penumbra ratio and negative CT perfusion).


Mean National Institutes of Health Stroke Scale (NIHSS) was 8.1 ± 4.9 at admission while 3.3 ± 5.1 at discharge, significantly different from admission (p < 0.001). As many as ten patients had mRS lower than 3 at discharge. Intracranial hemorrhage occurred in five patients and caused symptoms worsening only in two patients (decrease of NIHSS score of 4 points) of which one patient died.


The main finding of this study is that wake-up stroke with adequate selection by CT perfusion may benefit reperfusion treatment.


Wake-up stroke Reperfusion therapy Intravenous thrombolysis CT perfusion NIHSS 



The authors thank Matteo di Franza for the editorial assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Paola Caruso
    • 1
    Email author return OK on get
  • Marcello Naccarato
    • 1
  • Giovanni Furlanis
    • 1
  • Miloš Ajčević
    • 1
  • Lara Stragapede
    • 1
  • Mariana Ridolfi
    • 1
  • Paola Polverino
    • 1
  • Maja Ukmar
    • 2
  • Paolo Manganotti
    • 1
  1. 1.Clinical Unit of Neurology, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly
  2. 2.Radiology Unit, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly

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