Westchester Neurovascular Symposium: Advances in Stroke Care. Westchester Medical Center, Valhalla, NY, November 15, 2019. Guest Editors: Justin Santarelli MD and Ramandeep Sahni MDTime to Wake-Up: Extending the Window for Management of Unknown-Onset StrokesFawaz, Al-Mufti MD*,†; Wu, Sarah MS*; Viswanathan, Divya PA*; Kaur, Kavneet MD*; Nuoman, Rolla MD‡; Nuoaman, Halla MD*; Adnan, Yasir Ammar MD*; Gandhi, Chirag D. MD*,†; Kurian, Christeena MD*; Sahni, Ramandeep MD*Author Information From the *Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY †Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY ‡Department of Neurology, Maria Fareri Children’s Hospital—Westchester Medical Center at New York Medical College, Valhalla, NY. Disclosure: The authors have no conflicts of interest to report. Correspondence: Fawaz Al-Mufti, MD, Neuroendovascular Surgery and Neurocritical Care Attending, Westchester Medical Center at New York Medical College, 100 Woods Road, Macy Pavilion 1331, Valhalla, NY 10595. E-mail: [email protected]. Cardiology in Review: January/February 2021 - Volume 29 - Issue 1 - p 26-32 doi: 10.1097/CRD.0000000000000336 Buy Metrics Abstract The term “Wake-Up Stroke” is applied to a patient who displays no symptoms before sleep, but wakes with neurologic deficits suggestive of stroke. The current guidelines for acute ischemic stroke limit intravenous tissue plasminogen activator use to stroke patients in whom symptom onset or last known well is less than 4.5 hours. Approximately one-third of acute ischemic stroke patients present with unknown time of symptom onset and are often not eligible for intravenous reperfusion therapy in clinical practice. This review provides an overview of several earlier trials that used advanced neuroimaging to determine eligibility for reperfusion therapy in patients with unknown stroke onset. The reassuring results of these earlier trials that led to recent thrombolysis trials specifically targeted at “wake-up stroke” patients are discussed in this review. Ongoing studies aim to expand our knowledge regarding the safety and efficacy of thrombolysis in these patients. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.