Thrombolytic Therapy in Wake-Up Stroke Patients

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Wake-up stroke (WUS) presents diagnostic challenges regarding onset time.
• Thrombolytic therapy, like tissue plasminogen activator (tPA), is time-sensitive.
• Current guidelines often exclude WUS patients due to unknown onset time.

Purpose of the Study:

• To review existing and ongoing trial data on thrombolytic therapy for wake-up stroke patients.
• To identify potential strategies for selecting WUS patients who may benefit from thrombolysis.
• To assess the safety and efficacy of thrombolytic therapy in WUS.

Main Methods:

• Comprehensive literature search of PubMed and ClinicalTrials.gov.
• Inclusion of retrospective studies and ongoing trials evaluating WUS characteristics and treatment.
• Analysis of data on patient selection, treatment outcomes, and safety.

Main Results:

• Identified differences in tPA eligibility between WUS and known-onset stroke.
• Perfusion brain imaging shows potential for identifying WUS patients who could benefit from tPA.
• Studies indicate tPA treatment in WUS is associated with better outcomes and comparable safety.

Conclusions:

• Promising strategies are emerging to identify WUS patients suitable for thrombolysis.
• Completion of ongoing trials may lead to revised tPA eligibility criteria for WUS.
• Further research could expand treatment options for acute ischemic stroke in WUS patients.