Tissue Window in Stroke Thrombolysis study (TWIST): a safety study.
BACKGROUND: Stroke thrombolysis is limited by the "last-seen well" principle, which defines stroke onset time. A significant minority of stroke patients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were "last-seen well" at the t...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2013
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| _version_ | 1797050959999795200 |
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| author | Hill, MD Kenney, C Dzialowski, I Boulanger, J Demchuk, A Barber, P Watson, T Weir, N Buchan, A |
| author_facet | Hill, MD Kenney, C Dzialowski, I Boulanger, J Demchuk, A Barber, P Watson, T Weir, N Buchan, A |
| author_sort | Hill, MD |
| collection | OXFORD |
| description | BACKGROUND: Stroke thrombolysis is limited by the "last-seen well" principle, which defines stroke onset time. A significant minority of stroke patients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were "last-seen well" at the time they went to bed implying an interval that is most often greater than three hours. METHODS: A single-centre prospective, safety study was designed to thrombolyse 20 subjects with stroke-on-awakening. Patients were eligible for inclusion if they were last seen well less than 12 hours previously, specifically including those who awoke from sleep with their stroke deficits. They had a baseline computed tomogram (CT) scan with an ASPECTS score greater than 5, no evidence of well-evolved infarction and a CT angiogram / Trans-cranial Doppler ultrasound study demonstrating an intracranial arterial occlusion. Patients fulfilled all other standard criteria for stroke thrombolysis. The primary outcome was safety defined by symptomatic ICH or death. RESULTS: Among 89 screened patients, 20 were treated with thrombolysis. Two patients (10%) died due to massive carotid territory stroke and two patients (10%) died of stroke complications. Two patients (10%) showed asymptomatic intracerebral hemorrhage (ICH) (petechial hemorrhage) and none symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b) well-evolved infarcts on CT (19); (c) historical mRS > 2 (17); (d) no demonstrable arterial occlusion or were too mild to warrant treatment (10). CONCLUSIONS: Patients who awake with their deficits can be safely treated with thrombolysis based upon a tissue window defined by NCCT and CTA/TCD. |
| first_indexed | 2024-03-06T18:12:57Z |
| format | Journal article |
| id | oxford-uuid:03a38572-ad74-418d-a023-432dd8b2d8bf |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:12:57Z |
| publishDate | 2013 |
| record_format | dspace |
| spelling | oxford-uuid:03a38572-ad74-418d-a023-432dd8b2d8bf2022-03-26T08:47:24ZTissue Window in Stroke Thrombolysis study (TWIST): a safety study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:03a38572-ad74-418d-a023-432dd8b2d8bfEnglishSymplectic Elements at Oxford2013Hill, MDKenney, CDzialowski, IBoulanger, JDemchuk, ABarber, PWatson, TWeir, NBuchan, A BACKGROUND: Stroke thrombolysis is limited by the "last-seen well" principle, which defines stroke onset time. A significant minority of stroke patients (~15%) awake with their symptoms and are by definition ineligible for thrombolysis because they were "last-seen well" at the time they went to bed implying an interval that is most often greater than three hours. METHODS: A single-centre prospective, safety study was designed to thrombolyse 20 subjects with stroke-on-awakening. Patients were eligible for inclusion if they were last seen well less than 12 hours previously, specifically including those who awoke from sleep with their stroke deficits. They had a baseline computed tomogram (CT) scan with an ASPECTS score greater than 5, no evidence of well-evolved infarction and a CT angiogram / Trans-cranial Doppler ultrasound study demonstrating an intracranial arterial occlusion. Patients fulfilled all other standard criteria for stroke thrombolysis. The primary outcome was safety defined by symptomatic ICH or death. RESULTS: Among 89 screened patients, 20 were treated with thrombolysis. Two patients (10%) died due to massive carotid territory stroke and two patients (10%) died of stroke complications. Two patients (10%) showed asymptomatic intracerebral hemorrhage (ICH) (petechial hemorrhage) and none symptomatic ICH. Reasons for exclusion were: (a) ASPECTS ≤ 5 (29); (b) well-evolved infarcts on CT (19); (c) historical mRS > 2 (17); (d) no demonstrable arterial occlusion or were too mild to warrant treatment (10). CONCLUSIONS: Patients who awake with their deficits can be safely treated with thrombolysis based upon a tissue window defined by NCCT and CTA/TCD. |
| spellingShingle | Hill, MD Kenney, C Dzialowski, I Boulanger, J Demchuk, A Barber, P Watson, T Weir, N Buchan, A Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title | Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title_full | Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title_fullStr | Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title_full_unstemmed | Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title_short | Tissue Window in Stroke Thrombolysis study (TWIST): a safety study. |
| title_sort | tissue window in stroke thrombolysis study twist a safety study |
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