Abstract TMP16: Standardized Iv- Thrombolysis Using Non-Contrast CT in Wake-Up or Unknown Onset Stroke

Abstract

Introduction: Recent studies have shown that tPA can be safely administered beyond the standard 4.5hr window ( SW ) with good outcomes. However, patients were selected by multi-modal imaging, which is often unavailable outside of thrombectomy or comprehensive stroke centers ( CSC ). At our CSC, we developed a wake-up stroke ( WUS ) protocol based on a non-contrast CT. Safety and clinical outcomes are presented. Methods: Suspected ischemic stroke patients between 12/2015-12/2018 who received tPA at our CSC based on the WUS protocol (Table 1) were identified. Our group instituted this protocol in 2015 based on 10 yrs of previously published retrospective and prospective safety data. This protocol has been utilized to treat both WUS and unknown onset ( UKN ) patients. We compared baseline characteristics, tPA metrics, and outcome data between the SW and WUS/UKN patients. Symptomatic ICH ( sICH) was determined by SITS-MOST criteria. Results: At our center, 643 patients received tPA. Of these, 49 (7.6%) received tPA using the WUS protocol. Baseline characteristics were similar except WUS/UNK patients were less likely to have prior stroke history and more likely to go for endovascular therapy (Table 2). WUS/UKN patients had a median ASPECTS of 9 (IQR 7, 10) and had a mean last known well to arrival time of 9hrs. Length of stay, good functional outcome (mRS 0-2), and complications including sICH were comparable between SW and WUS/UKN patients. Conclusions: tPA appears safe and is potentially associated with comparable functional outcomes for select patients based on a non-contrast CT alone. Further studies are needed in the majority of stroke centers without multi-modal imaging capability.