Recanalisation therapies for wake-up stroke

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Review question: Do people who wake up with stroke benefit from treatments to reopen blood vessels (recanalisation therapies)?

Background: Most strokes are caused by a blockage of a blood vessel in the brain by a blood clot (ischaemic stroke), which are a leading cause of death and disability. Treatments to reopen blood vessels (such as clot-dissolving drugs or devices to remove blood clots) may improve recovery after ischaemic stroke if blood flow is rapidly restored.

About one in five strokes occur during sleep (wake-up stroke). People with wake-up stroke have traditionally been considered ineligible for recanalisation therapies because the time of stroke onset is unknown. However, some studies suggest that these people may benefit from recanalisation therapies.

Search date: We searched for randomised controlled trials (a type of experiment in which people are randomly allocated to one or more treatment groups) up until 9 January 2018.

Study characteristics: We included one trial with nine participants randomised to a recanalisation therapy or to placebo (dummy treatment). The trial was a feasibility study for perfusion computed tomography-guided thrombolysis in people with unknown onset of stroke.

Key results: There is insufficient evidence to determine if recanalisation therapies improve outcome in people with wake-up stroke. There are six ongoing trials that may contribute to our review when completed.

Quality of evidence: Low. There were insufficient data to assess the effect of treatment.