Wake up Symptomatic Stroke - Benefit of Intravenous Clot Busters or Endovascular Intervention

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