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      Recombinant Tissue-Type Plasminogen Activator Study of Wake-Up Ischemic Strokes Guided by Rapid MRI

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          Abstract

          Background: rt-PA intravenous thrombolytic therapy and its efficacy have been widely recognized and proved for strokes. However, for patients with wake-up ischemic stroke (WUIS), they lose the opportunity to receive rt-PA intravenous thrombolytic therapy because of the difficulty of determining the onset time window. Aim: This study is aimed at investigating the intravenous thrombolytic therapy of WUIS guided by rapid MRI. Methods: Data were collected from patients with acute ischemic stroke within 4.5 h and from WUIS patients with uncertain onset time window, who received the treatment of rt-PA intravenous thrombolytic therapy in our hospital from November 2006 to April 2018. The improved Rankin scale was used to evaluate neurological function recovery. According to the Rankin scale score, patients were divided into two groups: those with good prognosis (modified Rankin scale [mRS] score 0–1) and those with poor prognosis (mRS score 2–6). Results: A total of 253 patients received rt-PA intravenous thrombolysis after head MRI evaluation; this included 177 cases of acute ischemic stroke and 76 cases of WUIS (which contains 2 death cases, 0.8% mortality; 3 cases of symptomatic bleeding, 1.2% bleeding rate; and 5 cases of aggravation, 2.0% aggravation rate). There was no statistical difference between the baseline data from the acute ischemic stroke patients with 4.5 h onset time window and the baseline data from the WUIS patients with undetermined onset time window, when the treatment was guided by rapid MRI. There were also no significant statistical differences in National Institutes of Health Stroke Scale score, Rankin scale score, symptomatic bleeding, death and aggravation of the disease between the 2 groups at 24 h, 3 days, and 7 days after admission ( p < 0.05). Conclusion: According to the characteristic of undetermined onset time window of WUIS, more WUIS patients would be benefited from the rt-PA intravenous thrombolytic treatment when it is conducted under the guidance of rapid MRI.

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          Author and article information

          Journal
          CED
          Cerebrovasc Dis
          10.1159/issn.1015-9770
          Cerebrovascular Diseases
          S. Karger AG
          1015-9770
          1421-9786
          2019
          November 2019
          04 October 2019
          : 48
          : 1-2
          : 85-90
          Affiliations
          [_a] aDepartment of Neurology, Shanghai Pudong New Area Renmin Hospital (Affiliated to Shanghai Health Medical college), Shanghai, China
          [_b] bDepartment of Radiological Imaging, Shanghai Pudong New Area Renmin Hospital (Affiliated to Shanghai Health Medical college), Shanghai, China
          Author notes
          *Prof. Dr. CuiPing Guo, Department of Neurology, Shanghai Pudong New Area Renmin Hospital, 490 South Chuanhuan Road Pudong New Area, Shanghai 201299 (China), E-Mail guocuiping2010@gmail.com
          Article
          503379 Cerebrovasc Dis 2019;48:85–90
          10.1159/000503379
          31587000
          cb7797f6-5956-49af-b47d-0aa206426371
          © 2019 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          : 09 January 2019
          : 15 September 2019
          Page count
          Tables: 2, Pages: 6
          Categories
          Original Paper

          Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
          Wake-up ischemic strokes,Recombinant tissue plasminogen activator,Time window,Acute ischemic stroke

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