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Related Experiment Video

Updated: May 15, 2026

The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo
06:38

The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo

Published on: December 19, 2025

Tissue Window in Stroke Thrombolysis study (TWIST): a safety study.

Michael D Hill1, Carol Kenney, Imanuel Dzialowski

  • 1Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada. michael.hill@ucalgary.ca

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|December 20, 2012
PubMed
Summary

Thrombolysis for stroke patients who wake with symptoms is safe and effective when using advanced imaging to define treatment windows. This approach expands eligibility beyond the traditional "last-seen well" time limit.

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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Area of Science:

  • Neurology
  • Emergency Medicine
  • Radiology

Background:

  • The
  • last-seen well
  • principle limits thrombolysis for stroke patients who awaken with symptoms.
  • Approximately 15% of stroke patients are ineligible due to this time restriction.

Purpose of the Study:

  • To evaluate the safety and efficacy of thrombolysis in patients experiencing stroke upon awakening.
  • To extend thrombolytic treatment eligibility using advanced imaging criteria.

Main Methods:

  • A prospective, single-center safety study involving 20 patients with stroke-on-awakening.
  • Inclusion criteria: last seen well <12 hours, ASPECTS > 5, no evolved infarct, intracranial arterial occlusion on CT angiogram/Transcranial Doppler.
  • Primary outcome: safety, defined by symptomatic intracerebral hemorrhage (ICH) or death.

Main Results:

  • 20 out of 89 screened patients received thrombolysis.
  • 10% mortality rate (2 deaths from massive stroke, 2 from complications).
  • 10% experienced asymptomatic ICH; no symptomatic ICH occurred.

Conclusions:

  • Thrombolysis is safe for patients who awaken with stroke deficits.
  • Treatment can be guided by a "tissue window" established with non-contrast CT (NCCT) and CT angiogram/Transcranial Doppler (CTA/TCD).