Gurmeen Kaur, MBBS
Recently, the impressive results of the MRI-Guided Thrombolysis trial, popularly known as WAKE UP, were announced at the European Stroke Organization Conference 2018.
In an investigator initiated, multicenter, randomized, double blind, placebo controlled clinical trial, patients waking up with stroke or those with undetermined last known well because of aphasia and confusion were included between 18-80 years of age.
All patients included did not have contraindications to getting IV tPA, but did not qualify because of the unclear LKW. Previous studies have determined that at the 4.5-hour mark, roughly estimating, the DWI shows positivity but the FLAIR does not show parenchymal involvement. Hence, the mismatch between DWI and FLAIR was used to screen and select patients to be divided into 2 groups: one that received alteplase and the other group that received placebo. Interestingly, patients that qualified for mechanical thrombectomy were excluded from this trial.