Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke

Abstract

<b><p>Background</b> About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have previously been considered to be ineligiblefor thrombolytic treatment because the time of stroke onset is unknown. However, recent studies suggest benefit from recanalisationtherapies in selected patients.

<b><p>Objectives</b>

To assess the effects of intravenous thrombolysis and endovascular thrombectomy versus control in people with acute ischaemic strokepresenting on awakening from sleep.

<b><p>Search methods</b> We searched the Cochrane Stroke Group Trials Register (last search 24 of May 2021). In addition, we searched the following electronicdatabases in May 2021: Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 4 of 12, April 2021) in the Cochrane Library,MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We searched theStroke Trials Registry (last search 7 December 2017, as the site is currently inactive). We also screened references lists of relevant trials,contacted trialists, and undertook forward tracking of relevant references.

<b><p>Selection criteria</b>

Randomised controlled trials (RCTs) of intravenous thrombolytic drugs or endovascular thrombectomy treatments in people with acuteischaemic stroke presenting upon awakening.

<b><p>Data collection and analysis</b>

Two review authors applied the inclusion criteria, extracted data, and assessed risk of bias and the certainty of the evidence using theGRADE approach. We obtained both published and unpublished data for participants with wake-up strokes. We excluded participants withstrokes of unknown onset if the symptoms did not begin upon awakening.

<b><p>Main results</b>

We included seven trials with a total of 980 participants, of which five trials with 775 participants investigated intravenous thrombolytictreatment and two trials with 205 participants investigated endovascular thrombectomy in large vessel occlusion in the anteriorintracranial circulation. All trials used advanced imaging for selecting patients to treat.