Abstract TMP15: Thrombolysis in Stroke With Unknown Onset Based on Non-contrast Ct (TRUST CT). An International, Multicenter, Registry-based Study

Abstract

Background: Thrombolysis in wake-up stroke (WUS) or stroke with unknown onset (SUO) has been recently proven to be safe and effective using magnetic resonance imaging (MRI). However, in most of the thrombolyzing hospitals worldwide MR imaging is not available. We hypothesize that pragmatic non-contrast CT (NCCT)-based WUS/SUO thrombolysis may be feasible and safe. Methods: TRUST-CT is an international multicenter registry-based study. WUS/SUO patients undergoing NCCT-based thrombolysis with NIHSS ≥ 4 and initial ASPECTS ≥ 7 are included and compared to propensity score matched non-thrombolyzed WUS/SUO controls. Primary endpoint is symptomatic intracranial hemorrhage (ICH); secondary endpoints include 24-hour NIHSS change of ≥ 4 and modified Rankin Score (mRS) at 90 days. Results: Until now 100 patients with NCCT-based WUS/SUO thrombolysis were included. As compared to 100 controls, the median admission NIHSS was 9 and 8, respectively; the median ASPECTS was 10 in both groups. 3 (3 %) patients and 0 controls suffered symptomatic ICH. A decrease of ≥ 4 NIHSS points was observed in 48 % of the thrombolyzed patients as compared to 25% in the control group (p = 0.001); 33% and 28% achieved mRS 0 to 1 at 90 days, respectively (p = 0.4). Conclusions: NCCT-based thrombolysis in WUS/SUO seems feasible, safe and eventually effective. Updated results will be presented and discussed in the context of current evidence.