Background and Aims:
Efficacy and safety of reperfusion treatment in acute ischemic stroke was widely studied in known onset stroke patients, while the data on real world experience with rt-PA in Wake-up stroke (WUS) patients is limited. Even though WUS is observed in up to 25% of ischemic stroke patients, in clinical practice WUS patients are generally not treated with reperfusion therapy. The aim of this study was to investigate the efficacy and safety of thrombolysis in patients with WUS.

Methods:
We retrospectively analyzed the clinical and imaging data of WUS patients admitted to our Stroke Unit between March 2014 and March 2017. We evaluated the outcome of rt-PA treated and non-treated WUS patients in terms of NIHSS and mRS at discharge, sICH as well as mortality.

Results:
We studied 114 WUS patients (60 treated with rt-PA; 54 non-treated). Age, NIHSS, mRS, ASPECT at admission and time from last seen to admission were not significantly different between treated and non-treated patients. In the treated group NIHSS at discharge was significantly lower (median 1; range 0-21) compared to the non-treated (median 4; range 0-20). The number of patients with mRS 0-2 was significantly higher in the treated group compared to the non-treated (57% vs. 37%), while mortality and sICH did not differ.

Conclusions:
The main finding of this study is that WUS may benefit from rt-PA showing improvement in clinical outcome in terms of NIHSS and mRS at discharge, without additional risks.

EFFICACY AND SAFETY OF THROMBOLYSIS IN PATIENTS WITH WAKE-UP STROKE