Magnetic Resonance Imaging-Guided Intravenous Thrombolysis in Cardioembolic Stroke Patients With Unknown Time of Onset ― Subanalysis of the THAWS Randomized Control Trial ―
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- Yamazaki Naoya
- Department of Neurology, Iwate Prefectural Central Hospital
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- Koga Masatoshi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Doijiri Ryosuke
- Department of Neurology, Iwate Prefectural Central Hospital
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- Inoue Manabu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Miwa Kaori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Yoshimura Sohei
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Fukuda-Doi Mayumi
- Department of Data Science, National Cerebral and Cardiovascular Center
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- Aoki Junya
- Department of Neurology, Graduate School of Medicine, Nippon Medical School
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- Asakura Koko
- Department of Data Science, National Cerebral and Cardiovascular Center
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- Sasaki Makoto
- Institute for Biomedical Sciences, Iwate Medical University
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- Kitazono Takanari
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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- Kimura Kazumi
- Department of Neurology, Graduate School of Medicine, Nippon Medical School
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- Minematsu Kazuo
- Headquarters of the Iseikai Medical Corporation
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- Yamamoto Haruko
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center
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- Ihara Masafumi
- Department of Neurology, National Cerebral and Cardiovascular Center
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- Toyoda Kazunori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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Abstract
<p>Background: We investigated the clinical effect of intravenous thrombolysis using a magnetic resonance imaging (MRI)-guided approach in cardioembolic stroke (CE) patients with unknown time of onset.</p><p>Methods and Results: This subanalysis of the THAWS trial assessed the efficacy and safety of alteplase 0.6 mg/kg in CE patients with unknown time of onset and showing diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch. Patients were classified as CE and non-CE using the SSS-TOAST classification system during the acute period. The efficacy outcome was a modified Rankin Scale score of 0–1 at 90 days. In all, 126 patients from the THAWS trial were included in this study, of whom 45 (35.7%) were diagnosed with CE. In the CE group, a favorable outcome was numerically more frequent in the alteplase than control group (52% vs. 35%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 0.50–9.99). However, in the non-CE group, favorable outcomes were comparable between the alteplase and control groups (44% vs. 55%, respectively; aOR 0.39; 95% CI 0.12–1.21). Treatment-by-cohort interaction for a favorable outcome was modestly significant between the CE and non-CE groups (P=0.069). In the CE group, no patients experienced symptomatic intracranial hemorrhage (ICH) or parenchymal hematoma Type II following thrombolysis.</p><p>Conclusions: When an MRI-guided approach is used, CE patients with unknown time of onset appear to be suitable candidates for thrombolysis.</p>
Journal
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- Circulation Journal
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Circulation Journal 88 (3), 382-387, 2024-02-22
The Japanese Circulation Society
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Keywords
Details 詳細情報について
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- CRID
- 1390017754378672128
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- NII Book ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL BIB ID
- 033364686
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- PubMed
- 38220173
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- Text Lang
- en
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- Data Source
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- JaLC
- NDL
- Crossref
- PubMed
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- Abstract License Flag
- Disallowed