Estimating nocturnal stroke onset times by magnetic resonance imaging in the WAKE-UP trial
| Autor: | Salvador Pedraza, Christian Gerloff, Jochen B. Fiebach, Robin Lemmens, Eckhard Schlemm, Keith W. Muir, Alina Königsberg, Josep Puig, Matthias Endres, Martin Ebinger, Hans O. Pinnschmidt, Florent Boutitie, Claus Z Simonsen, Vincent Thijs, Götz Thomalla, Jens Fiehler, Anke Wouters, Bastian Cheng, Ivana Galinovic |
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| Rok vydání: | 2021 |
| Předmět: |
thrombolysis
medicine.medical_specialty Time Factors medicine.medical_treatment WAKE-UP Fluid-attenuated inversion recovery Nocturnal Brain Ischemia law.invention methods [Magnetic Resonance Imaging] Randomized controlled trial law Internal medicine methods [Diffusion Magnetic Resonance Imaging] Linear regression diagnostic imaging [Stroke] medicine Humans magnetic resonance imaging Thrombolytic Therapy ddc:610 Stroke Morning Ischemic stroke medicine.diagnostic_test business.industry Magnetic resonance imaging methods [Thrombolytic Therapy] Thrombolysis medicine.disease Magnetic Resonance Imaging drug therapy [Stroke] fluid-attenuated inversion recovery (FLAIR) Diffusion Magnetic Resonance Imaging Neurology Cardiology drug therapy [Brain Ischemia] business |
| Zdroj: | International journal of stroke 17(3), 323-330 (2022). doi:10.1177/17474930211059608 Cheng, B, Pinnschmidt, H, Königsberg, A, Schlemm, E, Boutitie, F, Ebinger, M, Endres, M, Fiebach, J B, Fiehler, J, Galinovic, I, Lemmens, R, Muir, K W, Pedraza, S, Puig, J, Simonsen, C Z, Thijs, V, Wouters, A, Gerloff, C & Thomalla, G 2022, ' Estimating nocturnal stroke onset times by magnetic resonance imaging in the WAKE-UP trial ', International Journal of Stroke, vol. 17, no. 3, pp. 323-330 . https://doi.org/10.1177/17474930211059608 |
| ISSN: | 1747-4949 1747-4930 |
| DOI: | 10.1177/17474930211059608 |
| Popis: | Background Fluid-attenuated inversion recovery (FLAIR) sequences have gained a role to guide treatment of patients with unknown time of stroke symptom onset. Evolution of signal intensities in FLAIR is associated with time since stroke onset with continuous linear increases. Aims Estimating symptom onset during night-sleep in patients from the WAKE-UP trial based on relative signal intensities FLAIR (FLAIR-rSI) from acute stroke lesions an independent dataset (PRE-FLAIR study). Methods FLAIR-rSI was quantified in stroke lesions in PRE-FLAIR and WAKE-UP. The PRE-FLAIR study was a multicenter observational trial establishing FLAIR as a surrogate parameter for time since stroke onset. WAKE-UP was a randomized controlled trial that revealed a benefit for alteplase in patients selected based on a DWI-FLAIR mismatch. Stroke onset times were recorded in PRE-FLAIR and used to fit a linear regression model with FLAIR-rSI, adjusted for patient age and lesion volume. The model was applied to FLAIR-rSI of stroke lesions to estimate onset times in those patients enrolled in WAKE-UP who had symptom onset during night-sleep. Results FLAIR-rSI was quantified in 399 patients from PRE-FLAIR. Linear regression indicated a significant association of age ( p = 0.001), lesion volume ( p = 0.005) and FLAIR-rSI ( p 2 = 0.179). In 813 patients from WAKE-UP, distribution of times of last seen well, symptom recognition and MRI examination were recorded. Median times of last seen well were 1 h before midnight (IQR 2.4 h) and symptom recognition 7 h after midnight (IRQ 2.2 h). Based on the FLAIR-rSI profiles, we estimated median stroke onset 6.1 h after midnight (IQR 2.7 h). Conclusion Nocturnal strokes during night-sleep may predominantly occur during the early morning hours. Our results are in line with evidence of characteristic diurnal patterns of cardiovascular events. |
| Databáze: | OpenAIRE |
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