MRI Mismatch Extends Alteplase to Unknown-Onset Stroke
WAKE-UP demonstrates that diffusion-weighted imaging/FLAIR mismatch can select wake-up and unknown-onset stroke patients for intravenous alteplase, expanding thrombolysis eligibility beyond the fixed 4.5-hour clock.
📅 Journal publication: Aug 16, 2018(online May 16, 2018)·Last updated: Jul 22, 2026
MRI-guided thrombolysis may benefit stroke of unknown onset.
This study explores extending thrombolysis to stroke patients with unknown onset times using MRI criteria, potentially increasing treatment options. Patients treated with intravenous alteplase showed a 53.3% favorable outcome compared to 41.8% with placebo, despite a higher rate of intracranial hemorrhage. Findings suggest potential benefits of alteplase for stroke patients with unknown onset times, though increased risk of bleeding must be considered. MRI-guided thrombolysis for unknown onset stroke may improve outcomes but with increased bleeding risk.
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Authors:Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho TH, Fazekas F, Fiehler J, Ford I, Galinovic I, Gellissen S, Golsari A, Gregori J, Günther M, Guibernau J, Häusler KG, Hennerici M, Kemmling A, Marstrand J, Modrau B, Neeb L, Perez de la Ossa N, Puig J, Ringleb P, Roy P, Scheel E, Schonewille W, Serena J, Sunaert S, Villringer K, Wouters A, Thijs V, Ebinger M, Endres M, Fiebach JB, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Gerloff C, WAKE-UP Investigators
Citation:Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. The New England journal of medicine. 2018;379(7):611-622. doi:10.1056/NEJMoa1804355