Wake-Up Stroke Protocol Becomes a Reality at Swedish Medical Center

60-year-old man becomes first patient in state of Colorado to be treated with IV alteplase according to Wake-Up protocol.
3D illustration of a brain stroke

November 10, 2020

Wake-Up Stroke Trial at Swedish Medical Center Gets Real

Under current guidelines, IV alteplase is standard of care for stroke patients IF the onset of stroke symptoms is known to be less than 4.5 hours. Previous studies have demonstrated that a DWI/FLAIR mismatch can indicate a stroke less than 4.5 hours. There are a large group of stroke patients who do not make it to the hospital in time to receive this treatment. In some cases, it is because the patient was sleeping and woke with symptoms and it is impossible to determine when the stroke started between going to bed and waking up.

How the Wake-Up Stroke Protocol Works

A new study at Swedish Medical Center in Colorado wanted to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on MRI would benefit from alteplase. This protocol uses DWI/FLAIR mismatch to allow for the possibility of IV alteplase treatment in stroke patients with a last known normal of > 4.5 hours. The MRI determines when the stroke likely began and whether it is safe to use IV alteplase. Patients were shown to benefit about as much as patients treated within the 3 hour FDA approved time window.

Groundbreaking Treatment and Achievement in Stroke Care

Recently, a 60 year old man presented to Swedish Medical Center having awoken with double vision and balance trouble. A complete neurological exam demonstrated quadrantanopia and dysarthria. Our Blue Sky Neurology team determined he met criteria for Wake-Up. He was able to consent to MRI, and was treated with IV alteplase according to the Wake-Up protocol.

The following day his neurological exam was normal, and he discharged home shortly thereafter. This was the first patient treated using this protocol in the State of Colorado and it is a testament to the pioneering team work between Blue Sky Neurology, its groundbreaking residency program and the Swedish Medical Center stroke team.