Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke

Mourand, Isabelle; Milhaud, D.; Arquizan, Caroline; Lobotesis, Kyriakos; Schaub, Roxane; Machi, Paolo; Ayrignac, Xavier; Bonafé, Alain; Costalat, Vincent

doi:10.3174/ajnr.a4574

Cited by 16 publications

(8 citation statements)

References 22 publications

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“…However, the incidence of symptomatic intracranial bleeding was higher, and the mortality rate was not significantly increased in alteplase group when compared to a placebo. Mourand et al (2015) used the DWI/FLAIR mismatch criteria to evaluate the safety and efficacy of thrombolysis and bridging therapy (thrombolysis followed by mechanical thrombectomy) in patients with wake-up strokes. The authors revealed that 52% of patients with wake-up strokes experienced favorable outcomes (mRs score = 0-2) at three months post-thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of intravenous thrombolytic treatment in wake‐up stroke: Experiences from a single center

Wiśniewski

2021

Brain and Behavior

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of intravenous thrombolytic treatment in wake‐up stroke: Experiences from a single center

Wiśniewski

2021

Brain and Behavior

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“…Only some patients (11% and 5%, respectively) received bridging therapy in the endovascular treatment arm of the DEFUSE-3 (11%) and DAWN (5%) trials [4,5]. In a different study, bridging therapy (n = 19) versus direct IVT (n = 21) was associated with 3-month favorable outcome in patients with large vessel occlusion in the anterior circulation and DWI/FLAIR-MRI mismatch [10].…”

Section: Discussionmentioning

confidence: 99%

Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset

Cappellari

Saia

Pracucci

et al. 2020

Euro J of Neurology

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Background and purpose: The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. Methods: A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. Results: Of the 349 patients with a 10-point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6-9-point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10-point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010-5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369-6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6-9-point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%).

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“…Several investigators have used this concept of DWI-FLAIR mismatch to guide thrombolytic therapy in WUS. [78][79][80] Outcomes in these patients in general were favorable and indicated that persons with WUS and DWI-FLAIR mismatch without contraindication to thrombolytic therapy may indeed benefit from this therapy without having excess risk of symptomatic hemorrhage.…”

Section: Magnetic Resonance Imaging (Mri) In Wusmentioning

confidence: 91%

Pathophysiologic mechanisms, neuroimaging and treatment in wake-up stroke

et al. 2019

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Wake-up stroke (WUS) or ischemic stroke occurring during sleep accounts for 14%–29.6% of all ischemic strokes. Management of WUS is complicated by its narrow therapeutic time window and attributable risk factors, which can affect the safety and efficacy of administering intravenous (IV) tissue plasminogen activator (t-PA). This manuscript will review risk factors of WUS, with a focus on obstructive sleep apnea, potential mechanisms of WUS, and evaluate studies assessing safety and efficacy of IV t-PA treatment in WUS patients guided by neuroimaging to estimate time of symptom onset. The authors used PubMed (1966 to March 2018) to search for the term “Wake-Up Stroke” cross-referenced with “pathophysiology,” ‘‘pathogenesis,” “pathology,” “magnetic resonance imaging,” “obstructive sleep apnea,” or “treatment.” English language Papers were reviewed. Also reviewed were pertinent papers from the reference list of the above-matched manuscripts. Studies that focused only on acute Strokes with known-onset of symptoms were not reviewed. Literature showed several potential risk factors associated with increased risk of WUS. Although the onset of WUS is unknown, a few studies investigated the potential benefit of magnetic resonance imaging (MRI) in estimating the age of onset which encouraged conducting clinical trials assessing the efficacy of MRI-guided thrombolytic therapy in WUS.

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Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke

Cited by 16 publications

References 22 publications

Safety and efficacy of intravenous thrombolytic treatment in wake‐up stroke: Experiences from a single center

Safety and efficacy of intravenous thrombolytic treatment in wake‐up stroke: Experiences from a single center

Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset

Pathophysiologic mechanisms, neuroimaging and treatment in wake-up stroke

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