Retrospective comparison of the outcome of patients, treated with intravenous thrombolysis with unknown versus known symptom onset, guided by CT-imaging
Conference Paper/Poster - Jan 16, 2019
Brugger Florian, Weber Johannes, Kägi Georg, Vehoff Jochen
The WAKE-UP trial showed a favourable outcome of intravenous thrombolysis with alteplase (iv-tPA) in patients with unknown onset of stroke, selected by DWI/FLAIR mismatch on MRI. In many centres, however, acute stroke patients are evaluated by CT-based imaging methods. We aimed at evaluating the outcome and safety of a multimodal CT-based decision making algorithm for iv-tPA in acute stroke patients with unknown symptom onset.
Retrospective, single centre analysis. Data from iv-tPA treated patients with unknown symptom onset and from those with a defined symptom onset <4.5 hours were retrieved from the Swiss Stroke Registry (SSR) from July 2014 until May 2018. Patients with endovascular treatment were excluded.
A mRS score of 0-1 after 90 days was observed in 16/28 patients with unknown symptom onset (57%). The rate of favourable outcome was comparable to patients treated within 4.5 hours after symptom onset (p=0.427). There was no difference between the two groups regarding the rates of sICH according to ECASS definition and death after 3 months.
CT-based selection of patients with unknown symptom onset for iv-tPA is feasible and seems to provide comparable efficacy and safety as in patients treated within the standard time window for iv-tPA of <4.5 hours after symptom onset. Meanwhile the results from the recently finished Extend Australia Study showed a benefit for iv-tPA in patients with wake-up stroke, selected by CT perfusion, compared to placebo.