International Stroke Conference 2025  /  Health Services, Quality Improvement, and Patient-Centered Outcomes Moderated Poster Tour II  /  Real World Experience of an MRI-Based Wake-Up Stroke Protocol For Acute Ischemic Stroke
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American Heart Association

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Final ID: TMP38

Real World Experience of an MRI-Based Wake-Up Stroke Protocol For Acute Ischemic Stroke

Abstract Body: Background: Randomized clinical trials have demonstrated that IV thrombolysis (IVT) can be administered safely in wake-up stroke (WUS) after MRI- or CT-based imaging selection to improve clinical outcomes. The objective of this study was to evaluate the utilization of IVT to treat WUS using a standardized WUS protocol across a healthcare system.

Methods: A WUS protocol using MRI-based imaging selection was implemented across an academic healthcare system with 6 acute care hospitals in the state of Georgia. We prospectively identified all WUS patients who underwent the WUS protocol over a 12 month period through August 15, 2024. Patients were eligible for the WUS protocol if they presented with disabling symptoms identified on awakening, had a CT head without contrast showing no hypodensity to explain clinical symptoms and had CT angiography of the head and neck demonstrating no large vessel occlusion as a cause of symptoms. All patients underwent expedited brain MRI sequences (DWI, T2w FLAIR, GRE) without contrast and IVT was administered at the discretion of the treating neurologist.

Results: During the study period, the WUS protocol was activated for 27 patients of which 6 (22%) received IVT (median NIHSS 10, IQR 5-15). Reasons for not receiving IVT included lack of DWI-FLAIR mismatch on MRI (n=11), DWI negative MRI (n=8), IVT declined by patient (n=1) and IVT contraindication (n=1). A modified Rankin scale of 0-1 at 90 days was achieved in 67% of WUS patients treated with IVT and no symptomatic intracerebral hemorrhages. Door-to-needle time within 60 minutes was significantly less likely in WUS compared with non-WUS cases (0% vs 69%, p=0.001). IVT administration in WUS patients made up 2% of all acute ischemic stroke patients receiving IVT.

Conclusions: An MRI-based WUS protocol was able to identify a small subset of acute ischemic stroke patients who met eligibility criteria for IVT outside of the 4.5 hour time window. IVT was associated with good clinical outcomes and not associated with any complications.
  • Westover, Deborah  ( Emory Healthcare , Atlanta , Georgia , United States )
  • Obideen, Mahmoud  ( Emory University , Alpharetta , Georgia , United States )
  • Groover, Olivia  ( Emory University , Alpharetta , Georgia , United States )
  • Shi, Hang Helen  ( Emory University , Alpharetta , Georgia , United States )
  • Memon, Aurangzeb  ( Emory St. Joseph's Hospital , Peachtree Corners , Georgia , United States )
  • Elson, Andrew  ( Emory University , Alpharetta , Georgia , United States )
  • Winkel, Daniel  ( Emory University , Atlanta , Georgia , United States )
  • Benameur, Karima  ( Emory University , Alpharetta , Georgia , United States )
  • Greene, James  ( Emory University , Alpharetta , Georgia , United States )
  • Segovis, Colin  ( Emory University , Alpharetta , Georgia , United States )
  • Hu, Ranliang  ( Emory University , Alpharetta , Georgia , United States )
  • Patel, Sumir  ( Emory University , Alpharetta , Georgia , United States )
  • Victor, Patricia  ( Emory Saint Joseph's Hospital , Atlanta , Georgia , United States )
  • Senter, Catherine  ( Emory University Hospital , Smyrna , Georgia , United States )
  • Campbell, Carol  ( Emory Healthcare , Decatur , Georgia , United States )
  • Ashraf, Shanza  ( Emory Healthcare , Atlanta , Georgia , United States )
  • Nahab, Fadi  ( Emory University , Alpharetta , Georgia , United States )
    • Author Disclosures:
    Deborah Westover: DO NOT have relevant financial relationships | Colin Segovis: DO NOT have relevant financial relationships | Ranliang Hu: DO have relevant financial relationships ; Researcher:Medtronic:Active (exists now) ; Individual Stocks/Stock Options:Pfizer:Active (exists now) ; Individual Stocks/Stock Options:Moderna:Active (exists now) | Sumir Patel: DO NOT have relevant financial relationships | Patricia Victor: DO NOT have relevant financial relationships | Catherine Senter: DO NOT have relevant financial relationships | Carol Campbell: No Answer | Shanza Ashraf: DO NOT have relevant financial relationships | Fadi Nahab: DO NOT have relevant financial relationships | Mahmoud Obideen: No Answer | Olivia Groover: No Answer | Hang Helen Shi: No Answer | Aurangzeb Memon: DO NOT have relevant financial relationships | Andrew Elson: DO NOT have relevant financial relationships | Daniel Winkel: DO NOT have relevant financial relationships | Karima Benameur: DO NOT have relevant financial relationships | James Greene: DO NOT have relevant financial relationships
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Health Services, Quality Improvement, and Patient-Centered Outcomes Moderated Poster Tour II

Thursday, 02/06/2025 , 06:00PM - 07:00PM

Moderated Poster Abstract Session

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