Can MRI Substitute for Time When Administering Intravenous Thrombolysis for Stroke?

When time of onset is unknown, using acute MRI to select acute stroke patients for intravenous thrombolysis leads to favorable outcomes but could increase risks.

Under current guidelines, when the time of stroke symptom onset is not known, such as when symptoms are recognized upon waking or in patients who cannot convey this information, clinicians use the time the patient was last known to be well to determine eligibility for intravenous thrombolysis. This conservative assumption is based on an increasing risk for hemorrhage and declining treatment benefit over time but probably leaves opportunities to safely treat certain patients unrealized.

In the WAKE-UP (MRI-Based Thrombolysis in Wake-Up Stroke) trial, investigators evaluated whether acute MRI findings consistent with stroke within 4.5 hours could serve as a proxy for time. In this trial, patients with stroke symptoms recognized upon awakening …

Reviewing Author

Anthony S. Kim, MD

Disclosures

Grant/Research SupportNIH/National Institute of Neurological Disorders and Stroke; NIH/National Center for Advancing Translational Sciences

Anthony S. Kim, MD

Disclosures

Grant/Research SupportNIH/National Institute of Neurological Disorders and Stroke; NIH/National Center for Advancing Translational Sciences

Can MRI Substitute for Time When Administering Intravenous Thrombolysis for Stroke?

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Reviewing Author