Acute stroke treatment - TWIST

Rapid restoration of blood supply to the affected parts of brain and prevention of futher tissue damage are essential in treatment of acute ischemic stroke. We study the effect of intravenous thrombolytic (blood clot dissolving) treatment in randomized controlled trials and by analysis of data from the national Norwegain quality registry of stroke (propensity-score matched analysis).  

TWIST - the Tenecteplase in Wake-up Ischemic Stroke Trial   

We studied the effect of treatment with tenecteplase in patients with wake-up stroke selected by plain CT (non-contrast CT) in an investigator-initiated international, multi-centre, prospective, randomised-controlled trial. The trial was stopped early due to the Covid-19 pandemic after 578 of the planned 600 patients had been included. Treatment with tenecteplase was not associated with better functional outcome for the primary outcome assessed as a shift in the score on the modified Rankin scale (mRS) at 90 days. The proportion with an excellent clinical outcome, defined as mRS score 0 or 1, was 45% in the tenecteplase group and 38% in the control group. There was no significant difference between treatment groups in risk of symptomatic intracranial hemorrhage or risk of death at 90 days.         

The next step is to merge TWIST data with data from other randomized-controlled trials on thrombolysis in wake-up stroke and/or thrombolysis, in order to do individual partcipant meta-analyses on the effect and safety of thrombolysis with tenecteplase for ischemic stroke and of thrombolysis in ischemic wake-up stroke.

Chief investigator: Ellisiv B. Mathiesen

Internal members: Melinda B. Roaldsen, Agnethe Eltoft, Mary-Helen Søyland, Stein Harald Johnsen 

External collaborators: Hanne Christensen (Dept. of Neurology, Copenhagen University Hospital, Denmark), Stefan T Engelter (Dept. of Neurology and Dept. of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland), Bent Indredavik (Dept. of Medicine, St Olavs University Hospital, and NTNU, Trondheim, Norway), Dalius Jatužis (Vilnius University, Center of Neurology, Vilnius, Lithuania), Guntis Karelis (Dept. of Neurology and Neurosurgery, Riga East University Hospital, and Rīga Stradiņš University, Riga, Latvia), Janika Kõrv (Dept. of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia), Erik  Lundström (Dept. of Medicine and Neurology, Uppsala University, Uppsala, Sweden), Jesper Petersson (Dept. of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden), Jukka Putaala (Dept. of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland) Arnstein Tveiten (Dept. of Neurology, Hospital of Southern Norway, Kristiansand, Norway), Andrew Bivard (Dept. of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia), Michael V Mazya (Dept. of Clinical Neuroscience, Karolinska Institutet, and Dept. of Neurology, Karolinska University Hospital, Stockholm, Sweden), David J Werring (Dept. of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK), Tom Wilsgaard (Dept. of Community Medicine, UiT), Teddy Y Wu (Dept. of Neurology, Christchurch Hospital, Christchurch, New Zealand), Gian Marco De Marchis (Dept. of Neurology, University Hospital Basel, and Dept. of Neurology, University of Basel, Basel, Switzerland), Thompson G Robinson (Dept. of Cardiovascular Sciences, University of Leicester, Leicester, UK).