Study for the Use of Alteplase in Patients Who Awaken With Stroke

Study Overview
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Brief Summary
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This is a pilot study of thrombolytic therapy in patients with ischemic stroke who present with stroke symptoms upon awakening.

Detailed Description
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Patients with ischemic stroke are currently only eligible for the treatment with intravenous thrombolysis if the stroke is diagnosed within 4.5 hours from known onset of symptoms. Many patients awaken with stroke and are excluded from this therapy, following current guidelines. Patients who suffer from a stroke just before or after waking up may be candidates for thrombolysis and our study will use advanced neuroimaging to select those patients.

Official Title
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Alteplase for Waking Onset STROKE

Conditions
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Ischemic Stroke

Intervention / Treatment
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* Drug: Alteplase (tPA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥22 Stroke upon awakening Measurable deficit by NIHSS No deficit before sleep or last seen normal before to sleep Head CT with no evidence of intracranial hemorrhage. Able to receive IV t-PA treatment within 2.5 hrs after patient awoke with deficit. Written informed consent signed and dated by the patient (or patient's authorized representative) Core lesion: ASPECTS ≥7 on MRI-DWI, CTP-CBV or CTA source imaging. Mismatch of at least 20% measured by CT CVB/MMT or DWI/TTP Exclusion Criteria: Stroke or serious head trauma within the preceding 3 months Major surgery or serious trauma within 14 days History of intracranial hemorrhage Systolic blood pressure above 185 mm Hg or diastolic blood pressure above 110 mm Hg that is not controlled after aggressive measures. Rapidly improving or minor symptoms Symptoms suggestive of subarachnoid hemorrhage. Gastrointestinal hemorrhage or urinary tract hemorrhage within the previous 21 days. Arterial puncture at a non-compressible site within the previous 7 days Seizure at the onset of stroke and considered the cause for the neurological symptom. Patients who are taking anticoagulants or who had received heparin within the 48 hours preceding the onset of stroke and have an elevated partial-thromboplastin time, INR>1.7 or platelet counts below 100,000/mm3 Finger sticks glucose below 50 mg/dl (2.7 mmol/ Lt) or above 400 mg per deciliter (22.2 mmol/Lt) and considered the cause for the neurological symptom. Active internal bleeding Pregnancy in women of child-bearing potential (must have pregnancy test, urine or blood, prior to therapy). Lumbar puncture within 7 days. Known co-morbid conditions likely to complicate therapy or interfere with patient assessment, such us: heart failure stage 4, severe dementia, end-stage AIDS, pericarditis, cirrhosis or known cancer. Unable to obtain CTA or perfusion brain studies (PWI or CTP)

Ages Eligible for Study
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Minimum Age: 22 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Alteplase<br>Alteplase 0.9mg/kg (maximum 90mg), 10% IV bolus over 1 minute and the remainder over one hour infusion in patients with ischemic stroke after awaking. | Drug: Alteplase (tPA)<br>* 0.9mg/KG (maximum 90mg), 10% bolus over one minutes, remainder over one hour.<br>* Other names: tPA;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Symptomatic Intracranial Hemorrhage | sICH is defined as any confluent dense hematoma occupying greater than 30% of the infarcted area with substantial space occupying effect, or any brain hemorrhage outside the infarcted area that occurs within 72 hours of tPA treatment and is associated with an increase of at least 4 points in the NIHSS. | 0-72 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Rankin Scale | A good outcome is defined as a modified Rankin Scale (mRS) of ≤1 or return to baseline mRS. | 90 days | 
| National Institutes of Health Stroke Scale (NIHSS) | An improvement of the NIHSS is defined as a 4-point improvement in the NIHSS, or NIHSS 0 measured 24 hours after treatment. | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke, ischemia, thrombolysis, thrombolytics, tPA, rt-PA, t-PA, Activase®, Alteplase, wake-up stroke, waking onset stroke, sleep