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Computed tomography perfusion-based thrombolysis in wake-up stroke

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Abstract

Wake-up stroke (WUS) patients are typically excluded from reperfusion treatment, as the time of symptoms onset is unknown. The purpose of this study is to evaluate the clinical outcome and safety of intravenous thrombolysis with rt-PA in patients with WUS eligible for therapy using computed tomography perfusion criteria (CTP), compared to patients treated with rt-PA within 4.5 h of symptoms onset (non-WUS). This is an experimental, open-label trial, controlled against the best therapy currently in use. Primary endpoints were functional independence after 3 months [modified Rankin scale (mRS) ≤ 1] for clinical outcome and symptomatic intracerebral hemorrhage (SICH) for safety. Secondary endpoints were no or only mild disability after 3 months (mRS ≤2) for clinical outcome, total intracerebral hemorrhage (TICH) and contrast-induced nephropathy (CIN) for safety. 170 patients were treated, 143 non-WUS patients and 27 patients with WUS. Strokes of cardioembolic origin were most common in WUS patients (p < 0.001). Primary endpoints: mRS ≤1 was found in 35.8 % (non-WUS: 36.4 % vs. WUS 33.3 %; p = 0.62) and SICH was observed in 3.4 % of non-WUS patients and in WUS patients (p = 0.32). Secondary endpoints: mRS ≤2 was observed in 66.4 % of patients (non-WUS: 67.1 % vs. WUS 62.9 %; p = 0.67), TICH in 13.5 % of patients (13.9 % non-WUS vs. 11.1 % WUS; p = 0.69). CIN was documented in 3.7 % of WUS patients. rt-PA treatment carried out in WUS patients selected on the basis of CTP data demonstrate comparable clinical outcome and safety with respect to non-WUS patients. The study supports the hypothesis that a selected group of WUS patients may be suitable for thrombolysis.

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Authors and Affiliations

  1. Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy

    Nicola Morelli, Eugenia Rota, Paolo Immovilli & Donata Guidetti

  2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Mirco Cosottini

  3. Emergency Department, Hospital of Val d’Arda, Piacenza, Italy

    Matteo Giorgi-Pierfranceschi

  4. Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy

    Andrea Magnacavallo

  5. Radiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy

    Nicola Morelli & Emanuele Michieletti

  6. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    John Morelli

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  1. Nicola Morelli
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Correspondence to Nicola Morelli.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Morelli, N., Rota, E., Immovilli, P. et al. Computed tomography perfusion-based thrombolysis in wake-up stroke. Intern Emerg Med 10, 977–984 (2015). https://doi.org/10.1007/s11739-015-1299-0

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  • DOI: https://doi.org/10.1007/s11739-015-1299-0

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