18
Emergency Evaluation and Treatment
Table 1. Imaging Criteria Used in the Extended Window
Thrombolysis Trials
Trial name Imaging criteria
WAKE-UP DWI/FLAIR mismatch: presence of an abnormal signal on DWI and no
visible signal change on FLAIR in the region of the acute stroke
THAWS DWI/FLAIR mismatch: presence of an abnormal signal on DWI and no
marked signal change on FLAIR in the region of the acute stroke
EPITHET PWI/DWI mismatch: PWI/DWI volume ratio >1.2 and PWI–DWI
volume ≥10 mL (PWI volume defined as Tmax >2 s)
ECASS-4 PWI/DWI mismatch: PWI/DWI volume ratio of ≥1.2 and PWI ≥20 mL
EXTEND CTP or DWI/PWI mismatch: ischemic penumbra to core volume ratio
>1.2, penumbra – core volume >10 mL, and core volume <70 mL (core
defined as <30% of normal regions on CTP or DWI volume; penumbra
defined as Tmax >6 s on CTP or PWI)
TIMELESS CTP or DWI/PWI mismatch: ischemic penumbra to core volume ratio
>1.8, penumbra volume >15 mL, and core volume <70 mL (core defined
as <30% of normal regions on CTP or DWI volume; penumbra defined
as Tmax >6 s on CTP or PWI using RAPID automated postprocessing )
TRACE-3 CTP or DWI/PWI mismatch: ischemic penumbra to core volume ratio
>1.8, penumbra volume >15 mL, and core volume <70 mL (core defined
as <30% of normal regions on CTP or DWI volume; penumbra defined
as Tmax >6 s on CTP or PWI using iStroke software)
CTP indicates computed tomographic perfusion; DWI, diffusion-weighted imaging ; FLAIR,
fluid-attenuated inversion recovery; and PWI, perfusion-weighted imaging.
3.3. Other Diagnostic Tests
COR LOE
Recommendations
1 C-LD
1. In patients with suspected acute stroke, baseline
electrocardiographic assessment is recommended but should
not delay initiation of IVT or EVT.
1 B-NR
2. In patients with suspected acute stroke, baseline troponin is
recommended but should not delay initiation of IVT or EVT.
