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Area of Science:

  • Neurology
  • Emergency Medicine
  • Radiology

Background:

  • Wake-up stroke (WUS) patients often miss reperfusion treatment due to unknown onset times.
  • Computed tomography perfusion (CTP) criteria may identify WUS patients suitable for therapy.

Purpose of the Study:

  • To compare the clinical outcomes and safety of intravenous thrombolysis with rt-PA in WUS patients selected by CTP versus non-WUS patients treated within 4.5 hours.
  • To evaluate functional independence (mRS ≤ 1) and symptomatic intracerebral hemorrhage (SICH) as primary endpoints.

Main Methods:

  • An open-label, experimental trial comparing WUS patients (n=27) selected by CTP with non-WUS patients (n=143) treated within 4.5 hours.
  • Primary endpoints: modified Rankin scale (mRS) ≤ 1 at 3 months; safety endpoint: symptomatic intracerebral hemorrhage (SICH).
  • Secondary endpoints included mRS ≤ 2, total intracerebral hemorrhage (TICH), and contrast-induced nephropathy (CIN).

Main Results:

  • Functional independence (mRS ≤ 1) was achieved in 33.3% of WUS patients versus 36.4% of non-WUS patients (p=0.62).
  • Symptomatic intracerebral hemorrhage (SICH) rates were comparable between groups (p=0.32).
  • No significant differences were observed in secondary endpoints like mRS ≤ 2, TICH, or CIN between WUS and non-WUS groups.

Conclusions:

  • Intravenous rt-PA treatment in WUS patients selected by CTP criteria demonstrates comparable clinical outcomes and safety to non-WUS patients.
  • A selected group of WUS patients may be suitable candidates for thrombolysis, expanding treatment eligibility.
  • CTP imaging is a valuable tool for identifying WUS patients who can safely receive rt-PA therapy.