Management of a wake-up stroke

Area of Science:

• Neurology
• Medical Imaging
• Emergency Medicine

Background:

• Current guidelines limit acute ischemic stroke treatment to 4.5-6 hours.
• Many patients present outside these time windows or have unknown onset times.
• Advances in neuroimaging offer potential for expanded therapeutic options.

Purpose of the Study:

• To review recent advances in late-window stroke treatment.
• To highlight the potential clinical impact of new imaging techniques for stroke patients.
• To discuss the application of MRI and CT perfusion in extending treatment eligibility.

Main Methods:

• Utilizing MRI diffusion/FLAIR mismatch to identify eligible patients within 4.5 hours.
• Employing CT perfusion imaging to select patients with large vessel occlusion for extended thrombectomy windows (up to 24 hours).
• Reviewing recent clinical studies and their findings on late-window stroke interventions.

Main Results:

• MRI diffusion/FLAIR mismatch can safely identify patients for thrombolysis within 4.5 hours.
• CT perfusion imaging identifies middle cerebral artery syndrome patients who may benefit from thrombectomy up to 24 hours.
• These methods enable treatment for a broader stroke patient population.

Conclusions:

• Recent advances in neuroimaging significantly expand treatment possibilities for acute ischemic stroke.
• MRI and CT perfusion are crucial tools for identifying suitable candidates for late-window interventions.
• These developments promise to revolutionize the management of stroke patients presenting beyond standard timeframes.