Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit

  • Giovanni Furlanis
  • Miloš Ajčević
  • Alex Buoite Stella
  • Tommaso Cillotto
  • Paola Caruso
  • Mariana Ridolfi
  • Maria Assunta Cova
  • Marcello Naccarato
  • Paolo ManganottiEmail author
Original Communication



Wake-Up Stroke (WUS) patients are generally excluded from thrombolytic therapy (rTPA) due to the unknown time of stroke onset. This study aimed to investigate the effects of rTPA in WUS patients during every day clinical scenarios, by measuring ischemic lesion volume and functional outcomes compared to non-treated WUS patients.


We retrospectively analyzed clinical and imaging data of 149 (75 rTPA; 74 non-rTPA) patients with acute ischemic WUS. Ischemic volume was calculated on follow-up CT and functional outcomes were the NIHSS and mRS comparing rTPA and non-rTPA WUS. Patients were selected using ASPECTS > 6 on CT and/or ischemic penumbra > 50% of hypoperfused tissue on CTP.


A reduced volume was measured on the follow-up CT for rTPA (1 mL, 0–8) compared to the non-rTPA patients (10 mL, 0–40; p = 0.000). NIHSS at 7 days from admission was significantly lower in the rTPA (1, 0–4) compared to non-rTPA group (3, 1–9; p = 0.015), as was the percentage of improvement (ΔNIHSS) (70% vs 50%; p = 0.002). A higher prevalence of mRS 0–2 was observed in the rTPA compared to the non-rTPA (54% vs 39%; p = 0.060). Multivariate analysis showed that NIHSS at baseline and rTPA treatment are significant predictors of good outcome both in terms of NIHSS at 7 days and ischemic lesion volume on follow-up CT (p < 0.05).


rTPA in WUS patients selected with CT and/or CTP resulted in reduced ischemic infarct volume on follow-up CT and better functional outcome without increment of intracranial hemorrhages and in-hospital mortality.


Wake-up stroke Thrombolysis Ischemic volume lesion Neuroimaging Decision-making 



M. Ajčević is supported by AIRAlzh Onlus-(ANCC-COOP). The authors would like to thank Matteo di Franza for editorial and proofreading assistance.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical standards

The research was conducted according to the principles of the Declaration of Helsinki. All participants released their informed consent for treatment of clinical data after all procedures had been fully explained, as for standard institutional procedure. This retrospective study was approved by the Local Ethics Committee CEUR (Comitato Etico Unico Regionale, FVG, Italy) with approval number 115/2018.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giovanni Furlanis
    • 1
  • Miloš Ajčević
    • 1
    • 2
  • Alex Buoite Stella
    • 1
  • Tommaso Cillotto
    • 1
  • Paola Caruso
    • 1
  • Mariana Ridolfi
    • 1
  • Maria Assunta Cova
    • 3
  • Marcello Naccarato
    • 1
  • Paolo Manganotti
    • 1
    Email author
  1. 1.Clinical Unit of Neurology, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly
  2. 2.Department of Engineering and ArchitectureUniversity of TriesteTriesteItaly
  3. 3.Radiology Unit, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly

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