Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/21862
Title: Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial.
Austin Authors: Galinovic, Ivana;Boutitie, Florent;Fiebach, Jochen B;Villringer, Kersten;Cheng, Bastian;Ebinger, Martin;Endres, Matthias;Fiehler, Jens;Ford, Ian;Thijs, Vincent N ;Lemmens, Robin;Muir, Keith W;Nighoghossian, Norbert;Pedraza, Salvador;Simonsen, Claus Z;Roy, Pascal;Gerloff, Christian;Thomalla, Götz
Affiliation: German Center for Neurodegenerative Diseases Within the Helmholtz Association, Partner Site Berlin, Bonn, Germany
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
Université Lyon 1, Villeurbanne, France
Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
VIB, Laboratory of Neurobiology, Center for Brain and Disease Research, Leuven, Belgium
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
Department of Stroke Medicine, Université Claude Bernard Lyon 1, Lyon, France
Department of Radiology, Hospital Dr. Josep Trueta, Institut de Diagnostic per la Image (IDI), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Issue Date: 11-Sep-2019
metadata.dc.date: 2019-09-11
Publication information: Frontiers in neurology 2019; 10: 983
Abstract: Introduction: In WAKE-UP (Efficacy and Safety of MRI-based Thrombolysis in Wake-Up Stroke), patients with an acute stroke of unknown onset time were randomized to treatment with intravenous alteplase or placebo, guided by MRI. Methods: In this exploratory post-hoc secondary analysis we compared clinical and imaging data, as well as treatment effects and safety of intravenous thrombolysis between patients with infra- vs. supratentorial stroke. Results: Forty-eight out of 503 randomized patients (9.5%) presented with a stroke involving the cerebellum or brainstem. Patients with infratentorial stroke were younger compared to patients with supratentorial stroke (mean age 60 vs. 66 years), more frequently male (85 vs. 62%), and less severely affected (median NIHSS 4.5 vs. 6.0). There was no heterogeneity for treatment effect between supratentorial (OR 1.67 95% CI 1.11-2.51) and infratentorial (OR 1.31 95% CI 0.41-4.22) sub-groups (test for interaction p = 0.70). In patients with infratentorial stroke, favorable outcome [a score of 0-1 on the modified Rankin scale (mRS) at 90 days] was observed in 12/22 patients (54.5%) in the alteplase group and in 13/25 patients (52.0%) in the placebo group (p = 0.59). The primary safety endpoint (death or mRS 4-6 at day 90) occurred in three patients of the alteplase group (13.6%) and three patients in the placebo group (12.0%); p = 0.74. Discussion: WAKE-UP was underpowered for demonstrating treatment effect in subgroup analyses however, based on our current results, there is no evidence to recommend withholding MRI-guided thrombolysis in patients with unknown onset stroke of infratentorial localization.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21862
DOI: 10.3389/fneur.2019.00983
ORCID: 0000-0002-6614-8417
PubMed URL: 31572293
ISSN: 1664-2295
Type: Journal Article
Subjects: MRI
WAKE-UP
alteplase
infratentorial infarct
infratentorial Stroke
intravenous thrombolysis
Appears in Collections:Journal articles

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