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Thrombolysis in wake-up stroke based on MRI mismatch.
Hassan Khan Ahmed1, Sara M Mathisen2, Kathinka Kurz3
1Neuroscience Research Group, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
Journal of the Neurological Sciences
|October 8, 2024
Summary
Wake-up stroke patients treated with intravenous thrombolysis using modified MRI mismatch criteria showed good outcomes. This approach, including partial mismatch, demonstrated the best clinical improvement without intracranial hemorrhage.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Magnetic Resonance Imaging (MRI) mismatch criteria guide intravenous thrombolysis (IVT) for wake-up stroke (WUPS) patients.
- Modified criteria now consider partial mismatch for IVT eligibility in WUPS.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of using modified MRI DWI/FLAIR mismatch criteria in WUPS patients treated with IVT.
- To assess the impact of including partial mismatch cases in WUPS treatment selection.
Main Methods:
- Retrospective analysis of WUPS patients treated with IVT at Stavanger University Hospital.
- MRI scans were reassessed using modified DWI/FLAIR mismatch criteria, including partial mismatch.
- Clinical outcomes (mRS, NIHSS) and intracranial hemorrhage (ICH) rates were analyzed at 3 months.
Main Results:
- Of 68 analyzed WUPS patients, 41 had DWI/FLAIR mismatch, 14 partial mismatch, and 13 match.
- Good functional outcomes (mRS 0-1) were achieved by 65.9%, 78.6%, and 61.5% in the mismatch, partial mismatch, and match groups, respectively.
- The mismatch group showed the most significant NIHSS improvement (p=0.005); no ICH occurred.
Conclusions:
- Extending the mismatch concept to include partial mismatch in WUPS patients is clinically feasible.
- The DWI/FLAIR mismatch criteria, including partial mismatch, are associated with favorable clinical outcomes in WUPS patients treated with IVT.
- This approach offers a safe and effective strategy for WUPS treatment selection.
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