Examination of Treatment Options According to Clinical Features and Radiological Findings in Wake-up Stroke

Yıl 2023, Cilt: 5 Sayı: Supplement (1) - Innovations in Medicine and Healthcare in the 100th Year of the Republic, 104 - 9, 19.10.2023

Tuba Ekmekyapar , Seval Demir Aydın

https://doi.org/10.37990/medr.1351847

Öz

Aim: Wake-up stroke patients account for one-fifth of all ischemic stroke patients and they have been deprived of recanalization treatment as the onset of the stroke is not known. It has come into the focus of recent research that this treatment could be applied to particularly patients who are selected on a radiological basis. We aimed to examine clinical and demographic characteristics of wake-up strokes.
Material and Methods: All ischemic stroke patients who presented to the emergency service throughout the night were analyzed. Patients with wake up stroke were recorded. The time of finding these patients, clinical features, treatment options and mortality status of these patients were examined. It was examined whether they received intravenous thrombolysis (IVT), endovascular therapy (EVT), or both as acute reperfusion therapy.
Results: Age, gender, the last time when they were seen healthy, treatment start time, treatment types, clinical classification, comorbid diseases, and discharge status of 72 wake-up stroke patients were analyzed. It was found that the time of discovery of 51.4% (n=37) of the wake-up stroke patients was 06.00 am and afterwards. Of these patients, 15.3% (n=11) received intravenous tissue plasminogen activator and/or endovascular treatment. These patients’ hospital stay durations, intracerebral hemorrhage status following the procedure, NIHSS scores, angiography findings, and mortality rates were examined. Here, mortality rate was found to be significantly high especially in patients with high NIHSS score.
Conclusion: Wake-up stroke is more common in the period close to the time of waking up in the morning. Recanylazation therapy should always be considered as an option in these patients.

Anahtar Kelimeler

Wake-up stroke , circadian rhythm , intravenous tissue plasminogen activator , endovascular treatment , NIHSS

Etik Beyan

Ethical approval for the study was obtained from Malatya Turgut Özal University Clinical Research Ethics Committee with the decision numbered 2021/88 and dated 13.10.2021.

Destekleyen Kurum

None.

Proje Numarası

None.

Teşekkür

None.

Kaynakça

• Cai Z, Zhao B, Deng Y, et al. Notch signaling in cerebrovascular diseases (Review). Mol Med Rep. 2016;14:2883-98.
• Ilic I, Ilic M, Sipetic Grujicic S. Trends in cerebrovascular diseases mortality in Serbia, 1997–2016: a nationwide descriptive study. BMJ Open. 2019;9:e024417.
• Chen SY, Cherng YG, Lee FP, et al. Risk of cerebrovascular diseases after uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a nationwide cohort study. Medicine (Baltimore). 2015;94:e1791.
• Tsivgoulis G, Psaltopoulou T, Wadley VG, et al. Adherence to a Mediterranean diet and prediction of incident stroke. Stroke. 2015;46:780-5.
• Heron M. Deaths: leading causes for 2015. Natl Vital Stat Rep. 2017;66:1-76.
• Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe-epidemiological update 2015. Eur Heart J. 2015;36:2696-705.
• Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med. 2001;37:202-16.
• Moradiya Y, Janjua N. Presentation and outcomes of “wake up strokes” in a large randomized stroke trial: analysis of data from the International Stroke Trial. J Stroke Cerebrovasc Dis. 2012;22:286-92.
• National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581-7.
• Campbell BC, Donnan GA, Lees KR, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol. 2015;14:846-54.
• Sun T, Xu Z, Diao SS, et al. Safety and cost-efectiveness thrombolysis by difusionweighted imaging and fuid attenuated inversion recovery mismatch for wake-up stroke. Clin Neurol Neurosurg. 2018;170:47-52.
• Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11-21.
• Zhang YL, Zhang JF, Wang XX, et al. Wake-up stroke: imaging-based diagnosis and recanalization therapy. J Neurol. 2021;268:4002-12.
• Thomalla G, Gerloff C. Treatment concepts for wake-up stroke and stroke with unknown time of symptom onset. Stroke. 2015;46:2707-13.
• Bassetti C, Aldrich M. Night time versus daytime transient ischaemic attack and ischaemic stroke. J Neurol Neurosurg Psychiatry. 1999;67:463-7.
• Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:581-641.
• Topçuoğlu MA, Arsava EM, Özdemir AÖ, et al. Intravenous thrombolytic therapy in acute stroke: problems and solutions. Turk J Neurol. 2017;23:162-75.
• Lago A, Geffner D, Tembl J, et al. Circadian variation in acute ischemic stroke a hospital-based study. Stroke. 1998;29:1873-5.
• Chaturvedi S, Adams HP, Woolson RF. Circadian variation in ischemic stroke subtypes. Stroke. 1999;30:1792-5.
• Serena J, Dávalos A, Segura T, et al. Stroke on awakening: looking for a more rational management. Cerebrovasc Dis. 2003;16:128-33.
• Bamford J, Sandercock P, Dennis M, et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337:1521-6.
• Zhong W, Geng N, Wang P, et al. Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis. Neurol Sci. 2016;37:1195-202.
• Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379:2364-72.
• Nogueira RG, Ribó M. Endovascular treatment of acute stroke. Stroke. 2019;50:2612-8.
• Barreto AD, Martin-Schild S, Hallevi H, et al. Thrombolytic therapy for patients who wake-up with stroke. Stroke. 2009;40:827-32.
• Kang DW, Sohn SI, Hong KS, et al. Reperfusion therapy in unclear-onset stroke based on MRI evaluation (RESTORE): a prospective multicenter study. Stroke. 2012;43:3278-83.
• Thomalla G, Cheng B, Ebinger M, et al. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4.5 h of symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol. 2011;10:978-86.
• Ebinger M, Galinovic I, Rozanski M, et al. Fluid-attenuated inversion recovery evolution within 12 hours from stroke onset: a reliable tissue clock? Stroke. 2010;41:250-5.
• Aoki J, Kimura K, Iguchi Y, et al. Intravenous thrombolysis based on diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch in acute stroke patients with unknown onset time. Cerebrovasc Dis. 2011;31:435-41.
• Fink JN, Kumar S, Horkan C, et al. The stroke patient who woke up: clinical and radiological features, including diffusion and perfusion MRI. Stroke. 2002;33:988-93.
• Barreto AD, Fanale CV, Alexandrov AV, et al. Prospective, open-label safety study of intravenous recombinant tissue plasminogen activator in wake-up stroke. Ann Neurol. 2016;80:211-8.
• Caruso P, Naccarato M, Furlanis G, et al. Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy. Neurol Sci. 2018;39:1705-12.
• Jovin TG, Saver JL, Ribo M, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017;12:641-52.
• Schwamm LH, Wu O, Song SS, et al. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Ann Neurol. 2018;83:980-93.
• Chen F, Ni YC. Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: an update. World J Radiol. 2012;4:63-74.
• Roveri L, La Gioia S, Ghidinelli C, et al. Wake-up stroke within 3 hours of symptom awareness: imaging and clinical features compared to standard recombinant tissue plasminogen activator treated stroke. J Stroke Cerebrovasc Dis. 2013;22:703-8.
• Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379:611-22.
• Schlemm L, Braemswig TB, Boutitie F, et al. WAKE-UP Investigators. Cerebral microbleeds and treatment effect of intravenous thrombolysis in acute stroke an analysis of the WAKE-UP randomized clinical trial. Neurology. 2022;98:e302-14.
• Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group. Stroke. 1997;28:2109-18.
• Roaldsen MB, Lindekleiv H, Mathiesen EB. Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke. Cochrane Database Syst Rev. 2021;12:CD010995.