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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...

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Tenecteplase in wake-up ischemic stroke trial: Protocol for a randomized-controlled trial.

Melinda B Roaldsen1,2, Haakon Lindekleiv3, Agnethe Eltoft1,2

  • 1Department of Neurology, University Hospital of North Norway, Tromsø, Norway.

International Journal of Stroke : Official Journal of the International Stroke Society
|January 15, 2021
PubMed
Summary

Tenecteplase may be safe and effective for wake-up ischemic stroke patients selected by non-contrast CT. The Tenecteplase in Wake-up Ischemic Stroke Trial (TWIST) compares tenecteplase plus standard care to standard care alone.

Keywords:
TWISTTenecteplaseacute ischemic strokeintravenous thrombolysiswake-up stroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Clinical Trials

Background:

  • Intravenous thrombolysis benefits select ischemic stroke patients with salvageable tissue.
  • The efficacy of thrombolysis in wake-up stroke patients not meeting advanced imaging criteria is unknown.
  • Non-contrast CT criteria may allow safe selection for thrombolytic treatment in wake-up strokes.

Purpose of the Study:

  • To evaluate the effect and safety of tenecteplase in wake-up ischemic stroke patients.
  • To compare tenecteplase plus standard care against standard care alone.
  • To assess treatment in patients selected using non-contrast CT criteria.

Main Methods:

  • The Tenecteplase in Wake-up Ischemic Stroke Trial (TWIST) is an international, multi-centre, randomized controlled trial.
  • 300 patients will receive tenecteplase plus standard care, and 300 will receive standard care alone.
  • The primary outcome is the modified Rankin Scale at three months, assessed within 4.5 hours of awakening.

Main Results:

  • This section is not available in the provided abstract.

Conclusions:

  • The TWIST trial aims to determine the efficacy and safety of tenecteplase for wake-up ischemic stroke patients identified via non-contrast CT.
  • Results will inform treatment guidelines for a broader population of wake-up stroke patients.