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RESTORE: MRI-based reperfusion therapy feasible strategy for unclear-onset strokes

Issue: March 2011

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International Stroke Conference 2011

Nearly 30% of patients with unclear-onset stroke who were treated with information from MRI had an ‘excellent’ outcome enabling them to carry out their usual activities, according to data from the RESTORE trial.

Researchers conducted the Reperfusion Therapy in Acute Ischemic Stroke with Unclear Onset by MRI evaluation (RESTORE) trial in six medical centers in South Korea. They included patients (n=430) with unclear-onset stroke who arrived at an ER within 6 hours of detecting symptoms.

According to Dong-Wha Wang, MD, PhD, associate professor, department of neurology, Aslan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea and presenter on behalf of the investigators, unclear-onset strokes occur when patients do not know when symptoms began, such as from a wake-up stroke or un-witnessed stroke. They account for a quarter of all ischemic stroke and have been automatically excluded from clot-busting treatment, he said.

Of the 430 patients, 83 (median age, 67 years) were treated with the use of MRI information. Overall, about 29% of patients had an ‘excellent outcome’ meaning they were able to carry out their usual activities, while roughly 45% of patients had at least a ‘good’ outcome characterized by no symptoms to a slight disability. Also noteworthy, factors for poor outcome included female sex, those who had more severe strokes at initial assessment and those who were treated at two medical centers lacking previous experience in thrombolysis for unclear-onset stroke.

“MRI-based reperfusion therapy in unclear-onset strokes is feasible and its safety and efficacy are comparable to those previous benchmark thrombolysis trials. But experience is required to achieve acceptable outcomes,” Wang said in his presentation. “Based on these observations, future large randomized controlled trials would be appropriate.” - by Brian Ellis

For more information:

• Kang D. Abstract 216. Presented at: International Stroke Conference 2011. Feb. 9-11, 2011; Los Angeles.

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