Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial

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 imagi...

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Autores: Galinovic, Ivana, Boutitie, Florent, Fiebach, Jochen B., Villringer, Kersten, Cheng, Bastian, Ebinger, Martin, Endres, Matthias, Fiehler, Jens, Ford, Ian, Thijs, Vincent, Lemmens, Robin, Muir, Keith W., Nighoghossian, Norbert, Pedraza, S., Simonsen, Claus Z., Pascal, Roy, Gerloff, Christian, Thomalla, Götz, WAKE-UP Consortium
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10256/18282
Acceso en línea:http://hdl.handle.net/10256/18282
Access Level:acceso abierto
Palabra clave:Teràpia trombolítica
Thrombolytic therapy
Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
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spelling Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP TrialGalinovic, IvanaBoutitie, FlorentFiebach, Jochen B.Villringer, KerstenCheng, BastianEbinger, MartinEndres, MatthiasFiehler, JensFord, IanThijs, VincentLemmens, RobinMuir, Keith W.Nighoghossian, NorbertPedraza, S.Simonsen, Claus Z.Pascal, RoyGerloff, ChristianThomalla, GötzWAKE-UP ConsortiumTeràpia trombolíticaThrombolytic therapyIsquèmia cerebral -- TractamentCerebral ischemia -- TreatmentIn 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 localizationFrontiers Media2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionpeer-reviewedapplication/pdfhttp://hdl.handle.net/10256/18282http://hdl.handle.net/10256/18282Frontiers in Neurology, 2019, vol. 10, art.núm. 983Articles publicats (IdIBGi)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)Inglésinfo:eu-repo/semantics/altIdentifier/doi/10.3389/fneur.2019.00983info:eu-repo/semantics/altIdentifier/issn/1664-2295Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10256/182822026-05-29T05:05:01Z
dc.title.none.fl_str_mv Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
title Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
spellingShingle Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
Galinovic, Ivana
Teràpia trombolítica
Thrombolytic therapy
Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
title_short Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
title_full Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
title_fullStr Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
title_full_unstemmed Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
title_sort Post-hoc Analysis of Outcome of Intravenous Thrombolysis in Infarcts of Infratentorial Localization in the WAKE-UP Trial
dc.creator.none.fl_str_mv Galinovic, Ivana
Boutitie, Florent
Fiebach, Jochen B.
Villringer, Kersten
Cheng, Bastian
Ebinger, Martin
Endres, Matthias
Fiehler, Jens
Ford, Ian
Thijs, Vincent
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Simonsen, Claus Z.
Pascal, Roy
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author Galinovic, Ivana
author_facet Galinovic, Ivana
Boutitie, Florent
Fiebach, Jochen B.
Villringer, Kersten
Cheng, Bastian
Ebinger, Martin
Endres, Matthias
Fiehler, Jens
Ford, Ian
Thijs, Vincent
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Simonsen, Claus Z.
Pascal, Roy
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author_role author
author2 Boutitie, Florent
Fiebach, Jochen B.
Villringer, Kersten
Cheng, Bastian
Ebinger, Martin
Endres, Matthias
Fiehler, Jens
Ford, Ian
Thijs, Vincent
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Simonsen, Claus Z.
Pascal, Roy
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Teràpia trombolítica
Thrombolytic therapy
Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
topic Teràpia trombolítica
Thrombolytic therapy
Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
description 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
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
peer-reviewed
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10256/18282
http://hdl.handle.net/10256/18282
url http://hdl.handle.net/10256/18282
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.3389/fneur.2019.00983
info:eu-repo/semantics/altIdentifier/issn/1664-2295
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Frontiers Media
publisher.none.fl_str_mv Frontiers Media
dc.source.none.fl_str_mv Frontiers in Neurology, 2019, vol. 10, art.núm. 983
Articles publicats (IdIBGi)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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