New Treatment Option For ‘Wake-up’ Stroke Patients

Source: University of Glasgow

Summary: According to a new research, a detail revealed in MRI brain scans can help doctors accurately deduce when a stroke begins and allows the treatment for many patients who currently cannot receive it.

Every year there are estimated to be over 100,000 strokes in the UK, including over 20,000 in patients with ‘wake-up stroke‘ or who otherwise have an unknown time of symptom onset. Up to 20% of stroke patients wake up in the morning with stroke symptoms. This means that the time when their stroke started is unknown and, as a result, they are not routinely eligible for clot-busting treatment (thrombolysis), which is only approved to be used within 4.5 hours after the start of stroke symptoms. The WAKE-UP trial – a major European study, which was led in the UK by the University of Glasgow – found that doctors were able to select patients who would benefit from clot-busting treatment based on the information from two different MRI scans. The findings could help to better treat stroke patients, particularly those who wake up with stroke symptoms. The study findings were published in the New England Journal of Medicine.

a patient awakens with stroke symptoms

Credit: University of Glasgow

Patients were studied using a combination of two different MRI sequences. The first scan, called diffusion-weighted imaging (DWI), shows early changes in the brain after stroke, whereas changes take several hours to become obvious in the second type of scan called FLAIR (fluid-attenuated inversion recovery). If changes are visible on one type of scan (DWI) but not the other (FLAIR), then a patient’s stroke is likely to have happened in the preceding 4.5 hours. The trial tested whether people with this pattern benefitted from thrombolysis using the clot-busting drug alteplase. Treatment with alteplase gave a significantly higher rate of full or nearly-full recovery 3 months after the stroke.

Prof. Keith Muir said, “The WAKE-UP trial proves that we can use MRI scanning effectively as a timer and that treating people with an MRI pattern indicating likely onset in the preceding few hours is highly beneficial.”

More Information: Götz Thomalla et al, “MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset, New England Journal of Medicine (2018). DOI: 10.1056/NEJMoa1804355 

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