MRI-Guided Thrombolysis in Stroke of Unknown Onset

Aug 26, 2023

null

Content

8.179 -> Intravenous thrombolysis is not recommended in acute ischemic stroke

11.966 -> if the time of onset is not known

14.16 -> or if the stroke occurred more than 4.5 hours earlier.

17.7 -> However, in some unwitnessed acute ischemic strokes,

20.12 -> including those with symptoms on awakening,

22.34 -> patients are unaware of the time of symptom onset.

25.32 -> MRI that shows an ischemic lesion on diffusion weighted images (or DWI)

30.34 -> but no marked parenchymal hyperintensity on fluid-attenuated inversion recovery

35.08 -> (or FLAIR) images in the same region, a DWI-FLAIR mismatch,

39.48 -> can be predictive of symptom onset within the previous 4.5 hours.

43.8 -> The role of intravenous thrombolysis in patients

45.82 -> with acute stroke of unknown time of symptom onset

48.72 -> and DWI-FLAIR mismatch is unclear.

52.51 -> In this multicenter, randomized, double-blind, placebo-controlled trial, 503 patients diagnosed

57.6 -> with stroke with an unknown time of symptom onset

60.32 -> and a DWI-FLAIR mismatch received intravenous alteplase or placebo.

65.4 -> The primary outcome was a favorable clinical outcome, defined as a score of 0, no symptoms,

70.84 -> or 1, no significant disability despite residual symptoms,

74.72 -> on the modified Rankin scale at 90 days after the stroke.

78.58 -> The primary outcome occurred in 53.3% of the alteplase group and 41.8% of the placebo group.

85.74 -> There were 10 deaths with alteplase and 3 with placebo,

89 -> a difference that was not statistically significant.

91.9 -> Clinically significant extracranial bleeding

93.94 -> was observed in 3 patients in the alteplase group,

96.3 -> but was not observed in the placebo group.

98.64 -> There was no difference in the rate of intracerebral hemorrhage.

101.84 -> The authors conclude that intravenous thrombolysis with alteplase improved functional outcomes

106.509 -> in stroke patients with unknown time of symptom onset and MRI findings of a DWI-FLAIR mismatch.

113.95 -> Full trial results are available at NEJM.org

Source: https://www.youtube.com/watch?v=jmOZIQI7Yhs