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Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy

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Abstract

Objective

Ischemic stroke is a neuroemergency condition highly treatable with thrombolysis and thrombectomy. Recently, observational studies have brought insights into clinical and imaging characteristics of wake-up stroke, which interested up to 25% of ischemic stroke patients. In clinical practice, wake-up strokes are usually not considered for reperfusion therapy. The aim of this study was to investigate the use CT perfusion imaging in patients with wake-up stroke and to assess the effect of neuroimaging information provided by CT perfusion maps on the efficacy and safety of thrombolysis and thrombectomy.

Patients and method

We studied 22 wake-up stroke (WUS) patients (13F/9M mean age) who underwent reperfusion therapy after the eligibility assessed by the CT perfusion imaging (< 50% core-to-penumbra ratio and negative CT perfusion).

Results

Mean National Institutes of Health Stroke Scale (NIHSS) was 8.1 ± 4.9 at admission while 3.3 ± 5.1 at discharge, significantly different from admission (p < 0.001). As many as ten patients had mRS lower than 3 at discharge. Intracranial hemorrhage occurred in five patients and caused symptoms worsening only in two patients (decrease of NIHSS score of 4 points) of which one patient died.

Conclusion

The main finding of this study is that wake-up stroke with adequate selection by CT perfusion may benefit reperfusion treatment.

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Acknowledgements

The authors thank Matteo di Franza for the editorial assistance.

Author information

Authors and Affiliations

  1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy

    Paola Caruso, Marcello Naccarato, Giovanni Furlanis, Miloš Ajčević, Lara Stragapede, Mariana Ridolfi, Paola Polverino & Paolo Manganotti

  2. Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy

    Maja Ukmar

Authors
  1. Paola Caruso
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  2. Marcello Naccarato
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  3. Giovanni Furlanis
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Correspondence to Paola Caruso.

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Caruso, P., Naccarato, M., Furlanis, G. et al. Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy. Neurol Sci 39, 1705–1712 (2018). https://doi.org/10.1007/s10072-018-3486-z

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  • DOI: https://doi.org/10.1007/s10072-018-3486-z

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