Background: Patients who present with stroke symptoms upon awakening, often referred to as wake-up stroke (WUS), account for approximately 25% of acute ischemic strokes. In this group, onset time is unknown. Due to the unknown time of onset, patients with WUS are often excluded from consideration of aggressive stroke treatment and are generally treated with routine medical management only. However, through the use of advanced imaging and rapid interpretation of findings, we have found that selected WUS patients may benefit from endovascular stroke therapies. We identified the need for a standardized protocol to ensure that all WUS patients are urgently assessed as candidates for aggressive management.
Purpose: The purpose of this project was to establish a standardized protocol, including a one-call alert system and pre-set orders for advanced diagnostic imaging, to be used in the quick determination of a treatment plan for patients presenting with WUS.
Methods: A protocol was created by the stroke team. The stroke team responds to the one-call alert system, advanced diagnostics are rapidly performed, and a decision regarding endovascular treatment is made by the Interventional Radiologist. Education was provided to all major stakeholders including all Neurologists, Emergency Department Physicians and staff, Radiologists, Stroke Nurse Practitioners, Emergency Medical Providers, Diagnostic Imaging and Special Procedures staff. Wake-Up Stroke alert activations, procedures, and outcomes are monitored by the Stroke Coordinator.
Results: Wake Up Stroke Protocol was published for use in February 2015. Within the 90-day period immediately following, 16 Stroke Alert activations were called for WUS patients. Eight of the 16 were deemed to be candidates for endovascular stroke therapy. Of the eight patients treated, the average improvement in NIHSS score is 5.5 points (range 0-14).
Conclusion: In conclusion, the WUS Protocol is effective in the rapid identification of patients who could benefit from endovascular stroke therapies.