Acute endovascular recanalization therapy in wake-up stroke

Up to 15-25% of patients with ischemic stroke wake up with their deficits. Because of the uncertainty about the time of onset, these patients are generally not offered thrombolytic therapy. Some of these wake-up stroke patients may be eligible for acute endovascular stroke therapy based on hyperacute CT or MR imaging independent of the time window.

We report two patients with acute ischemic stroke whose symptoms were present upon awakening and who were successfully treated with endovascular interventions.

The first patient was discharged with complete neurological recovery on second day after endovascular intervention. The second patient went home on fifth day with a mild left facial paresis and left arm drift. Both these patients did not have any neurological deficit on 18-month follow up.

Some patients who present with stroke on awakening may be candidates for thrombolytic therapy or recanalization techniques irrespective of mode of therapy (intravenous, intravenous+intra-arterial or intra-arterial tPA alone). Further randomized, controlled studies are warranted to safely identify those candidates who would benefit from thrombolysis and endovascular interventions in ischemic wake-up strokes.