Giovanni Furlanis1, Miloš Ajčević1,2, Alex Buoite Stella1, Tommaso Cillotto1, Paola Caruso1, Mariana Ridolfi1, Maria Assunta Cova3, Marcello Naccarato1, Paolo Manganotti4. 1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. 2. Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio, 10, 34127, Trieste, Italy. 3. Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. 4. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. pmanganotti@units.it.
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.
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-rTPApatients (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.
Authors: J Mackey; D Kleindorfer; H Sucharew; C J Moomaw; B M Kissela; K Alwell; M L Flaherty; D Woo; P Khatri; O Adeoye; S Ferioli; J C Khoury; R Hornung; J P Broderick Journal: Neurology Date: 2011-05-10 Impact factor: 9.910
Authors: Götz Thomalla; Claus Z Simonsen; Florent Boutitie; Grethe Andersen; Yves Berthezene; Bastian Cheng; Bharath Cheripelli; Tae-Hee Cho; Franz Fazekas; Jens Fiehler; Ian Ford; Ivana Galinovic; Susanne Gellissen; Amir Golsari; Johannes Gregori; Matthias Günther; Jorge Guibernau; Karl Georg Häusler; Michael Hennerici; André Kemmling; Jacob Marstrand; Boris Modrau; Lars Neeb; Natalia Perez de la Ossa; Josep Puig; Peter Ringleb; Pascal Roy; Enno Scheel; Wouter Schonewille; Joaquin Serena; Stefan Sunaert; Kersten Villringer; Anke Wouters; Vincent Thijs; Martin Ebinger; Matthias Endres; Jochen B Fiebach; Robin Lemmens; Keith W Muir; Norbert Nighoghossian; Salvador Pedraza; Christian Gerloff Journal: N Engl J Med Date: 2018-05-16 Impact factor: 91.245
Authors: Pablo Hervella; María Luz Alonso-Alonso; María Pérez-Mato; Manuel Rodríguez-Yáñez; Susana Arias-Rivas; Iria López-Dequidt; José M Pumar; Tomás Sobrino; Francisco Campos; José Castillo; Ramón Iglesias-Rey Journal: BMC Neurol Date: 2022-06-09 Impact factor: 2.903
Authors: Miloš Ajčević; Giovanni Furlanis; Aleksandar Miladinović; Alex Buoite Stella; Paola Caruso; Maja Ukmar; Maria Assunta Cova; Marcello Naccarato; Agostino Accardo; Paolo Manganotti Journal: Ann Biomed Eng Date: 2021-02-18 Impact factor: 3.934