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OUTCOME OF INTRAVENOUS THROMBOLYSIS IN INFARCTS OF INFRATENTORIAL LOCALIZATION IN THE WAKE-UP TRIAL

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ESOC-2019

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Abstract

Background and Purpose We investigated the efficacy and safety of MRI-guided intravenous thrombolysis in unknown onset stroke in a subgroup of patients of the WAKE-UP trial presenting with infratentorial stroke. Methods The clinical and imaging data, demographic characteristics and effect of thrombolysis on outcome were compared between patients with infra- vs supratentorial stroke. The analysis of primary and secondary endpoints as in the original WAKE-UP trial analysis was repeated in the subpopulation of infratentorial stroke patients. Results Forty-eight out of 503 WAKE-UP patients (9.5%) presented with a stroke involving the pons, the medulla oblongata, the cerebellum or the mesencephalon. Infratentorial stroke patients were younger, more often male and had lower infarct volumes and NIHSS scores at baseline than supratentorial stroke patients. The treatment response was not significantly different between these two groups (test for interaction, p=0.70). In patients with infratentorial stroke, favourable outcome (mRS of 0-1 at 90 days) was observed in 12 out of 22 patients (54.5%) in the alteplase group and in 13 out of 25 patients (52.0%) in the placebo group (adjusted OR, 1.38; 95% CI 0.42-4.56; p=0.59).The primary safety endpoint (death or mRS 4-6 at day 90) occurred in 3 patients of the alteplase group (13.6%) and 3 patients in the placebo group (12.0%); p=1.00. Conclusions Our results show no evidence for a difference in the safety or treatment effect of MRI-guided thrombolysis in unknown onset stroke between patients with infratentorial and supratentorial infarcts. However, WAKE-UP was not powered for demonstrating superiority in subgroup analyses.

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© Copyright 2020 Morressier GmbH.
All rights reserved.