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

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.

Hyper-acute EEG alterations predict functional and morphological outcomes in thrombolysis-treated ischemic stroke: a wireless EEG study

“…Our study is the first that investigated early pre-thrombolysis predictive power of EEG features. The obtained results in homogeneous cohort are important because of growing diffusion of reperfusion therapy [22,27] also in timeextended cases [2,4,7,8,15,20,25], and may thus contribute to guiding treatment and rehabilitation strategies in the earliest phase of ischemic event in the era of personalized medicine.…”

“…Perfusion neuroimaging, such as MRI and CTP techniques, are crucial in ischemic stroke assessment and patient selection due the identification of ischemic core and salvageable hypoperfused penumbra [15,16,21,26] However, these techniques are not feasible tools to monitor brain ischemia evolution in the acute phase. Brain oscillatory activity changes occurring in acute ischemic stroke are related to neurophysiological changes (measured by EEG) in the cerebral tissue during hypoperfusion as manifestation of neurovascular coupling [29,32].…”

“…Thrombolytic therapy delivered within 4.5 h from stroke onset significantly improves the overall odds of a good stroke outcome [27]. Recent studies highlighted the efficacy and safety of thrombolytic treatment in extended time window, too (4.5-9 h from stroke onset or wake-up stroke) in patients selected by advanced neuroimaging [7,8,15,20].…”

A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper‐acute ischaemic stroke patients

“…A univariate analysis was performed to investigate the association of different factors, including hydration status, with CTP parameters as mismatch (penumbra volume/total hypoperfused volume) and total hypoperfused volume. Factors that were associated with these parameters with p < .10 were included in the stepwise multivariable model, as previously described (Furlanis et al., 2019). Results are presented as β and 95% confidence intervals (CI).…”

“…Computed tomography perfusion (CTP) imaging is a well‐validated technique used in emergency setting to help identifying in the hyper‐acute phase the irreversible infarct volume (core) and surrounding salvageable hypoperfused tissue (penumbra) (Gonzalez, 2006). Recently, CTP has been characterized by a growing research interest, and its parameters are well associated with clinical presentation and functional outcomes after ischaemic stroke (Albers et al., 2018; Caruso et al., 2018; Campbell et al., 2019; Furlanis et al., 2018, 2020; Haranhalli et al., 2019; Manganotti et al., 2019; Stragapede et al., 2019; Vilela & Rowley, 2017).…”