Stroke- on- Awakening: Safety of CT-CTA Based Selection for Reperfusion Therapy

Can J Neurol Sci. 2014 Mar;41(2):182-6. doi: 10.1017/s0317167100016553.


Background: We studied the safety of use of acute reperfusion therapies in patients with stroke- on- awakening using a computed tomographic angiography (Cta) based large vessel occlusion-good scan paradigm in clinical routine.

Methods: the Cta database of the Calgary stroke program was reviewed for the period January 2003-March 2010. patients with stroke-on-awakening with large artery occlusions on Cta, who received conservative, iV thrombolytic and/or endovascular treatment at discretion of the attending stroke neurologist were analyzed. time of onset was defined by the time last seen or known to be normal. Baseline non-contrast Ct scan (nCCt) alberta Stroke program early Ct Score (aSpeCtS) > 7 was considered a good scan. hemorrhage was defined on follow-up brain imaging using eCaSS 3 criteria. independence (mrS≤2) at three months was considered a good clinical outcome. Standard descriptive statistics and multivariable analysis were done.

Results: among 532 patients with large artery occlusions, 70 patients with stroke-on-awakening (13.1%) were identified. the median age was 69.5 (iQr 24) and 41 (58.6%) were female; 41 (58.6%) received anti-platelets only and 29 (41.4%) received thrombolytic treatment [iV-12 (17.1%), iV/ia-12 (17.1%) and ia-5(7.1%)]. unadjusted analysis showed that baseline nCCt aSpeCtS ≤ 7 (p=0.002) and higher nihSS scores (p=0.018) were associated with worse outcomes. there were no ph2 hemorrhages in the iV thrombolytic or endovascular treated group. functional outcome was not different by treatment.

Conclusion: When carefully selected using Ct –Cta, by a good scan (aSpeCtS > 7) occlusion paradigm, acute reperfusion therapies in patients with stroke-on-awakening can be performed safely in clinical routine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / complications
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / drug therapy*
  • Cerebral Angiography
  • Cerebral Hemorrhage / chemically induced*
  • Cohort Studies
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Retrospective Studies
  • Stroke / diagnostic imaging
  • Stroke / drug therapy*
  • Stroke / etiology
  • Thrombolytic Therapy / methods*
  • Time-to-Treatment*
  • Tissue Plasminogen Activator / therapeutic use*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wakefulness*


  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Tissue Plasminogen Activator