Outcomes of Wake-Up Stroke in the Mechanical Thrombectomy Era

Authors

  • Patis Chunhachatrachai Warinchamrab Hospital, Ubon Ratchathani Thailand
  • Pornpatr Dharmasaroja Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani Thailand

Keywords:

stroke, wake-up, thrombolysis, mechanical thrombectomy

Abstract

A substantial portion of stroke patients wake up with stroke, and they are likely excluded from intravenous alteplase treatment due to unknown time of onset. Currently, mechanical thrombectomy (MT) is approved to treat selected patients with large vessel occlusion (LVO) within 24 hours. This may change outcomes in these patients.

Objective: The aim of the study was to evaluate the causes and outcomes in patients with non-wake-up stroke compared to wake-up stroke.

Methods: Patients with acute ischemic stroke during September, 2022 to March, 2023 were studied. All patients were investigated and treated according to the standard stroke protocol in the certified stroke unit. Causes and outcomes were compared in patients between non-wake-up and wake-up stroke.

Results: A total of 693 patients were included, with 138 patients (19.9%) presenting as wake-up stroke. The etiologies of stroke were nonsignificantly different between non-wake-up and wake-up stroke. MT was performed in 18% of patients in each group. Intravenous alteplase alone was given to 14.2% of patients with non-wake-up stroke, but none in the wake-up group. Favorable outcome at 3 months revealed a nonsignificant difference (non-wake-up: 54% vs wake-up:55%, p=0.83). A slightly higher death rate (6.8% vs 2.2%, p=0.037) and symptomatic intracerebral hemorrhage (5.4% vs 1.4%, p=0.188) were found in patients with non-wake-up compared to wake-up stroke.

Conclusion: In the MT era, the rate of favorable outcome in wake-up stroke patients did not significantly differ from that observed in non-wake-up stroke cases, despite none of the wake-up stroke patients being treated with intravenous alteplase alone.

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Published

2025-08-30

How to Cite

1.
Chunhachatrachai P, Dharmasaroja P. Outcomes of Wake-Up Stroke in the Mechanical Thrombectomy Era. J Thai Stroke Soc [internet]. 2025 Aug. 30 [cited 2025 Dec. 28];24(2):5. available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/280186

Issue

Vol. 24 No. 2 (2025): May - August 2025

Section

Original article

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