BACKGROUND: Stroke thrombolysis is limited by the "last-seen well" principle, which defines stroke onset time. A significant minority of stroke patients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were "last-seen well" at the time they went to bed implying an interval that is most often greater than three hours. METHODS: A single-centre prospective, safety study was designed to thrombolyse 20 subjects with stroke-on-awakening. Patients were eligible for inclusion if they were last seen well less than 12 hours previously, specifically including those who awoke from sleep with their stroke deficits. They had a baseline computed tomogram (CT) scan with an ASPECTS score greater than 5, no evidence of well-evolved infarction and a CT angiogram / Trans-cranial Doppler ultrasound study demonstrating an intracranial arterial occlusion. Patients fulfilled all other standard criteria for stroke thrombolysis. The primary outcome was safety defined by symptomatic ICH or death. RESULTS: Among 89 screened patients, 20 were treated with thrombolysis. Two patients (10%) died due to massive carotid territory stroke and two patients (10%) died of stroke complications. Two patients (10%) showed asymptomatic intracerebral hemorrhage (ICH) (petechial hemorrhage) and none symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b) well-evolved infarcts on CT (19); (c) historical mRS > 2 (17); (d) no demonstrable arterial occlusion or were too mild to warrant treatment (10). CONCLUSIONS: Patients who awake with their deficits can be safely treated with thrombolysis based upon a tissue window defined by NCCT and CTA/TCD.
BACKGROUND:Stroke thrombolysis is limited by the "last-seen well" principle, which defines stroke onset time. A significant minority of strokepatients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were "last-seen well" at the time they went to bed implying an interval that is most often greater than three hours. METHODS: A single-centre prospective, safety study was designed to thrombolyse 20 subjects with stroke-on-awakening. Patients were eligible for inclusion if they were last seen well less than 12 hours previously, specifically including those who awoke from sleep with their stroke deficits. They had a baseline computed tomogram (CT) scan with an ASPECTS score greater than 5, no evidence of well-evolved infarction and a CT angiogram / Trans-cranial Doppler ultrasound study demonstrating an intracranial arterial occlusion. Patients fulfilled all other standard criteria for stroke thrombolysis. The primary outcome was safety defined by symptomatic ICH or death. RESULTS: Among 89 screened patients, 20 were treated with thrombolysis. Two patients (10%) died due to massive carotid territory stroke and two patients (10%) died of stroke complications. Two patients (10%) showed asymptomatic intracerebral hemorrhage (ICH) (petechial hemorrhage) and none symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b) well-evolved infarcts on CT (19); (c) historical mRS > 2 (17); (d) no demonstrable arterial occlusion or were too mild to warrant treatment (10). CONCLUSIONS:Patients who awake with their deficits can be safely treated with thrombolysis based upon a tissue window defined by NCCT and CTA/TCD.
Authors: K Barlinn; J Seibt; K Engellandt; J Gerber; V Puetz; J Kepplinger; O Wunderlich; L-P Pallesen; U Bodechtel; R Koch; R von Kummer; I Dzialowski Journal: Clin Neuroradiol Date: 2014-08-23 Impact factor: 3.649
Authors: Lee H Schwamm; Ona Wu; Shlee S Song; Lawrence L Latour; Andria L Ford; Amie W Hsia; Alona Muzikansky; Rebecca A Betensky; Albert J Yoo; Michael H Lev; Gregoire Boulouis; Arne Lauer; Pedro Cougo; William A Copen; Gordon J Harris; Steven Warach Journal: Ann Neurol Date: 2018-04-27 Impact factor: 10.422
Authors: J W Evans; B R Graham; P Pordeli; F S Al-Ajlan; R Willinsky; W J Montanera; J L Rempel; A Shuaib; P Brennan; D Williams; D Roy; A Y Poppe; T G Jovin; T Devlin; B W Baxter; T Krings; F L Silver; D F Frei; C Fanale; D Tampieri; J Teitelbaum; D Iancu; J Shankar; P A Barber; A M Demchuk; M Goyal; M D Hill; B K Menon Journal: AJNR Am J Neuroradiol Date: 2017-11-30 Impact factor: 3.825