title: Thrombolysis as a factor associated with favorable outcomes in patients with unclear-onset stroke.
abstract: OBJECTIVE
  Clinical and radiological features of patients with unclear-onset stroke do not differ significantly from those with known-onset stroke. There is a lack of evidence for the safety and efficacy of thrombolysis in patients with unclear-onset stroke. We sought to provide supportive data on the safety and efficiency of thrombolysis in patients with unclear-onset stroke.
  
  
  METHODS
  We retrospectively identified patients with unclear-onset stroke (<3 h of first found abnormal time) from our stroke registry. We performed following protocols for thrombolysis in patients with unclear-onset stroke; initial conventional CT-based intravenous thrombolysis (IVT), repeat MRI during IVT, and then decision to maintain IVT or to perform combined intra-arterial thrombolysis. In addition, we compared clinical outcomes and safety between thrombolyzed and non-thrombolyzed patients.
  
  
  RESULTS
  A total of 78 patients with unclear-onset stroke were included. Twenty-nine patients underwent thrombolysis. Thrombolysis (OR, 6.842; 95% CI, 1.950-24.004; P = 0.003) and baseline NIHSS (OR, 0.769; 95% CI, 0.645-0.917; P = 0.003) were associated with favorable outcomes at 3 months in multivariate logistic regression analysis. The frequency of hemorrhagic transformation and symptomatic ICH was not significantly different between the thrombolyzed and non-thrombolyzed patients (34.4% vs. 40.7% and 10.3% vs. 8.2%, respectively).
  
  
  CONCLUSIONS
  The results of this study suggest that thrombolysis in unclear-onset stroke could be independently associated with favorable outcomes at 3 months and that thrombolysis based on repeat imaging appears to be safely applied to patients with unclear-onset stroke.
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea. alldelight2@jnu.ac.kr
authors.forename: J-T
authors.initials: JT
authors.lastname: Kim
authors.forename: M-S
authors.initials: MS
authors.lastname: Park
authors.forename: T-S
authors.initials: TS
authors.lastname: Nam
authors.forename: S-M
authors.initials: SM
authors.lastname: Choi
authors.forename: B-C
authors.initials: BC
authors.lastname: Kim
authors.forename: M-K
authors.initials: MK
authors.lastname: Kim
authors.forename: K-H
authors.initials: KH
authors.lastname: Cho
mesh_terms: D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents