Oral
Presentation on Neuroimaging
Topic
: The Thrombolytic Therapy for Wake-Up Stroke Base on Neuroimaging:
Yes or No?-A Meta-analysis of Comparative Studies
Presenter
: Lihuan Lan
Sun Yat-Sen University, China
Abstract
Background : Intravenous recombinant tissue
plasminogen activator is a preferred therapy for patients with acute ischemic
stroke within 4.5 hours. But patients with unknown stroke
onset usually excluded from the standard thrombolytic therapy.
Although some existing studies which evaluated conducted the thrombolytic
therapy for patients with unknown stroke onset or wake-up stroke, there have
been no comprehensive meta-analyses of the effect of thrombolytic therapy for
these patients. We performed the first meta-analysis to evaluate the effect of
thrombolytic therapy for patients with wake-up stroke or unknown stroke onset.
Methods: Articles were screened from
electronic database in September 2017 and all randomized controlled trials and retrospective comparative
studies were included.
Results: Two randomized controlled
trials, three retrospective studies, one prospective, multicenter, single-arm
study, one case-controlled study and one open-label pilot study including 964
patients. The control group had lower National Institutes of Health stroke
scale score (95% CI 0.62 – 4.26; p = 0.009). For excellent clinical outcome
(mRS, 0–1), no significant difference was found between experiment group and
control group (OR1.76; 95% CI 0.71 – 4.35; p = 0.22). There was not
statistically significant when we compared the favorable clinical outcome (mRS,
0–2)between both groups (OR1.42; 95% CI 0.85 – 2.36; p = 0.18). Intracranial hemorrhage
of control group were lower than experiment group (OR1.81; 95% CI 1.00 – 3.37;
p = 0.05). But the mortality between both group was not statistically
significant (OR1.29; 95% CI 0.64 – 2.59; p = 0.47).
Conclusion:
Intravenous rt-PA in patients with WUS based on neuroimaging didn't improve
clinical prognosis. However the ICH rate was statistically significant higher
for experiment group than control group. More well-designed RCTs are needed to evaluate
the effect of intravenous rt-PA for WUS.
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