Wake up Symptomatic Stroke - Benefit of Intravenous Clot Busters or Endovascular Intervention
Wake up Symptomatic Stroke - Benefit of Intravenous Clot Busters or Endovascular Intervention
The purpose of the trial is to study the safety and the effectiveness of using CT Perfusion
 studies as an indicator to treat stroke patients with unknown time of onset.
Inclusion Criteria:

 Inclusion Criteria: To be eligible for entry into this study, candidates must meet all of
 the following eligibility criteria at the time of Emergency Department presentation:

 1. Age: 18-80 years old

 2. Ischemic Wake Up Stroke (Unknown time of onset but less than 24 hours since last seen
 normal)

 3. National Institute of Health Stroke Scale (NIHSS) 8-22

 4. Evidence of penumbra on Computed Tomography Perfusion(CTP) as mentioned above

 5. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS 7 or more)

 6. Signed informed consent

 Exclusion Criteria:

 Exclusion Criteria: Potential study patients will be excluded from study entry if any of
 the following exclusion criteria exist at the time of screening:

 1. Evidence of intracranial hemorrhage (Intracerebral hematoma, intraventricular
 hemorrhage, subarachnoid hemorrhage (SAH), epidural hemorrhage, acute or chronic
 subdural hematoma (SDH)) on the baseline CT

 2. Historical Modified Rankin Scale (mRS) of ≥2

 3. National Institute of Health Stroke Scale (NIHSS)<8 at the time of treatment

 4. Positive pregnancy test in women at age of childbearing

 5. Intracranial or intraspinal surgery within 3 months

 6. Stroke or serious head injury within 3 months

 7. History of intracranial hemorrhage

 8. Uncontrolled hypertension at time of treatment (eg, >185 mm Hg systolic or >110 mm Hg
 diastolic)

 9. Seizure at the onset of stroke

 10. Active internal bleeding

 11. Intracranial neoplasm

 12. Arteriovenous malformation or aneurysm

 13. Clinical presentation suggesting post-MI pericarditis

 14. Known bleeding diathesis including but not limited to current use of oral
 anticoagulants producing an Internation normalized ratio (INR) >1.7

 15. Internation normalized ratio (INR) >1.7

 16. Administration of heparin within 48 hours preceding the onset of stroke with an
 elevated activated Partial Thromboplastin Time(aPTT) at presentation

 17. Platelet count <100,000/mm

 18. Major surgery within 2 weeks

 19. GastroIntestinal (GI) or urinary tract hemorrhage within 3 weeks

 20. Aggressive treatment required to lower blood pressure

 21. Glucose level <50 or >400 mg/dL

 22. Arterial puncture at a noncompressible site or lumbar puncture within 1 week