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01-03-2020 | Stroke | Original Communication

Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit

Authors: Giovanni Furlanis, Miloš Ajčević, Alex Buoite Stella, Tommaso Cillotto, Paola Caruso, Mariana Ridolfi, Maria Assunta Cova, Marcello Naccarato, Paolo Manganotti

Published in: Journal of Neurology | Issue 3/2020

Abstract

Backgrounds

Wake-Up Stroke (WUS) patients are generally excluded from thrombolytic therapy (rTPA) due to the unknown time of stroke onset. This study aimed to investigate the effects of rTPA in WUS patients during every day clinical scenarios, by measuring ischemic lesion volume and functional outcomes compared to non-treated WUS patients.

Methods

We retrospectively analyzed clinical and imaging data of 149 (75 rTPA; 74 non-rTPA) patients with acute ischemic WUS. Ischemic volume was calculated on follow-up CT and functional outcomes were the NIHSS and mRS comparing rTPA and non-rTPA WUS. Patients were selected using ASPECTS > 6 on CT and/or ischemic penumbra > 50% of hypoperfused tissue on CTP.

Results

A reduced volume was measured on the follow-up CT for rTPA (1 mL, 0–8) compared to the non-rTPA patients (10 mL, 0–40; p = 0.000). NIHSS at 7 days from admission was significantly lower in the rTPA (1, 0–4) compared to non-rTPA group (3, 1–9; p = 0.015), as was the percentage of improvement (ΔNIHSS) (70% vs 50%; p = 0.002). A higher prevalence of mRS 0–2 was observed in the rTPA compared to the non-rTPA (54% vs 39%; p = 0.060). Multivariate analysis showed that NIHSS at baseline and rTPA treatment are significant predictors of good outcome both in terms of NIHSS at 7 days and ischemic lesion volume on follow-up CT (p < 0.05).

Conclusions

rTPA in WUS patients selected with CT and/or CTP resulted in reduced ischemic infarct volume on follow-up CT and better functional outcome without increment of intracranial hemorrhages and in-hospital mortality.

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Title: Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit
Authors: Giovanni Furlanis
Miloš Ajčević
Alex Buoite Stella
Tommaso Cillotto
Paola Caruso
Mariana Ridolfi
Maria Assunta Cova
Marcello Naccarato
Paolo Manganotti
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Journal of Neurology / Issue 3/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09603-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit

Abstract

Backgrounds

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Backgrounds

Methods

Results

Conclusions

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