New treatment option for 'wake-up' stroke patients

May 16, 2018, University of Glasgow
New treatment option for ‘wake-up’ stroke patients
Credit: University of Glasgow

Detail revealed in MRI brain scans can help doctors accurately deduce when a stroke begins, according to new research, allowing treatment for many patients who currently cannot receive it.

The findings could help to better treat , particularly those who wake up with stroke symptoms. Currently, those who do not know when their stroke began are not routinely eligible for clot-busting treatment, which is only able to be used a few hours after stroke symptoms start.

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 study is published in the New England Journal of Medicine and the findings were presented at the European Stroke Organisation Conference (ESOC).

Up to 20 percent 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 .

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.

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: 53% of patients treated with alteplase made a full or nearly-full recovery compared to 42% in the placebo group, representing an absolute increase of 11.5%. This means that for every 9 people treated, one extra person made a complete recovery.

Professor Keith Muir, SINAPSE Chair of Clinical Imaging at the University's Institute of Neuroscience & Psychology, and Chief Investigator and coordinator of the trial in the UK, said: "Clot-busting drug treatment is effective only in the first few hours after a stroke, so it has not been possible up until now to treat patients when the stroke happens during sleep, for example. This involves as many as 1 in 5 people affected by a stroke.

"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.

"The trial should significantly increase the opportunities for treatment in stroke. Around 1 in 3 of the patients enrolled in the trial had the MRI signature of recent onset, and could be expected to be eligible for treatment that they have been unable to receive in the past. This translates into several thousand additional people per year in the UK.

"This important advance brings the possibility of treatment to many more stroke patients, but the challenge is to ensure availability of immediate MRI scanning. Unlike other countries, the UK has very poor access to emergency MRI, so it will need the UK to make immediate access to MRI scanning a priority."

Juliet Bouverie, Chief Executive at the Stroke Association, which was a consortium member on the trial, said: "These findings could be a game-changer for the thousands of people who have a stroke in their sleep so can't receive thrombolysis.

"Stroke is a medical emergency and there is a only a small window of opportunity to receive that can reduce brain damage. The impact of a stroke means it can affect someone's mobility, vision, memory and even their personality, robbing them of the life they had.

"Everyone who has had a stroke should be given the best chance of recovery. If the use of this new brain scan technique were rolled out across the UK, it has the potential to save thousands of survivors from serious physical and mental disability."

Explore further: Imaging may allow safe tPA treatment of patients with unwitnessed strokes

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

Related Stories

Imaging may allow safe tPA treatment of patients with unwitnessed strokes

April 25, 2018
A study led by Massachusetts General Hospital (MGH) investigators may lead to a significant expansion in the number of stroke patients who can safely be treated with intravenous tPA (tissue plasminogen activator), the "clot ...

Prompt clot-grabbing treatment produces better stroke outcomes

January 25, 2018
Clot removal may be beneficial up to 24 hours following stroke in carefully selected patients, but every hour delayed after symptoms begin may be associated with more disability, according to preliminary research presented ...

A better clot-buster drug for strokes?

April 26, 2018
(HealthDay)—After a stroke, many patients are given the clot-busting intravenous drug alteplase, but another drug may be more effective, Australian researchers report.

Cancer patients less likely to receive clot-busting drugs after stroke

January 26, 2018
When a stroke occurs in patients with cancer, they are one-third less likely to receive standard clot-busting medication as patients without a malignancy, according to preliminary research presented at the American Stroke ...

Safe to treat dementia patients with clot-busting drugs

October 9, 2017
Stroke patients with dementia treated with intravenous thrombolysis using powerful clot-busting drugs are at no higher risk of brain haemorrhage or death than other patients receiving the same treatment, a study from Karolinska ...

Clot-busting drugs appear safe for treating 'wake-up' stroke patients

February 1, 2012
Clot-busting drugs may be safe for patients who wake up experiencing stroke symptoms, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2012.

Recommended for you

Genetic analysis links obesity with diabetes, coronary artery disease

November 16, 2018
A Cleveland Clinic genetic analysis has found that obesity itself, not just the adverse health effects associated with it, significantly increases the risk of Type 2 diabetes and coronary artery disease. The paper was published ...

Non-coding genetic variant could improve key vascular functions

November 15, 2018
Atherosclerotic disease, the slow and silent hardening and narrowing of the arteries, is a leading cause of mortality worldwide. It is responsible for more than 15 million deaths each year, including an estimated 610,000 ...

Study of two tribes sheds light on role of Western-influenced diet in blood pressure

November 14, 2018
A South American tribe living in near-total isolation with no Western dietary influences showed no increase in average blood pressure from age one to age 60, according to a study led by researchers at Johns Hopkins Bloomberg ...

Heart failure patients shouldn't stop meds even if condition improves: study

November 13, 2018
(HealthDay)—There's bad news for heart failure patients with dilated cardiomyopathy who'd like to stop taking their meds.

Bypass beats stents for diabetics with heart trouble: study

November 13, 2018
(HealthDay)—People with both diabetes and multiple clogged heart arteries live longer if they undergo bypass surgery rather than have their blood vessels reopened with stents, according to follow-up results from a landmark ...

Kawasaki disease: One disease, multiple triggers

November 12, 2018
Researchers at University of California San Diego School of Medicine, Scripps Institution of Oceanography, and international collaborators have evidence that Kawasaki Disease (KD) does not have a single cause. By studying ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.