Magnetic Resonance Imaging-Guided Intravenous Thrombolysis in Cardioembolic Stroke Patients With Unknown Time of Onset　― Subanalysis of the THAWS Randomized Control Trial ―

DOI Web Site Web Site PubMed 1 Citations 22 References
  • Yamazaki Naoya
    Department of Neurology, Iwate Prefectural Central Hospital
  • Koga Masatoshi
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Doijiri Ryosuke
    Department of Neurology, Iwate Prefectural Central Hospital
  • Inoue Manabu
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Miwa Kaori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Yoshimura Sohei
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Fukuda-Doi Mayumi
    Department of Data Science, National Cerebral and Cardiovascular Center
  • Aoki Junya
    Department of Neurology, Graduate School of Medicine, Nippon Medical School
  • Asakura Koko
    Department of Data Science, National Cerebral and Cardiovascular Center
  • Sasaki Makoto
    Institute for Biomedical Sciences, Iwate Medical University
  • Kitazono Takanari
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Kimura Kazumi
    Department of Neurology, Graduate School of Medicine, Nippon Medical School
  • Minematsu Kazuo
    Headquarters of the Iseikai Medical Corporation
  • Yamamoto Haruko
    Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center
  • Ihara Masafumi
    Department of Neurology, National Cerebral and Cardiovascular Center
  • Toyoda Kazunori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • for the THAWS Trial Investigators

Search this article

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

  • Circulation Journal

    Circulation Journal 88 (3), 382-387, 2024-02-22

    The Japanese Circulation Society

Citations (1)*help

See more

References(22)*help

See more

Keywords

Details 詳細情報について

Report a problem

Back to top