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156. Association of cholesterol levels with hemorrhagic transformation and cerebral edema after reperfusion therapies

Author

Escudero-Martínez, Irene, Thorén, Magnus, Matusevicius, Marius, Cooray, Charith, Zini, Andrea, Roffe, Christine, Toni, Danilo, Tsivgoulis, Georgios, Ringleb, Peter, Wahlgren, Nils, and Ahmed, Niaz

Abstract

Background: The association between cholesterol levels and cerebral edema (CED) or hemorrhagic transformation (HT) as an expressions of blood-brain barrier (BBB) dysfunction after ischemic stroke is not well established. The aim of this study is to determine the association of total cholesterol (TC) levels with the incidence of HT and CED after reperfusion therapies.Methods: We analyzed SITS Thrombolysis and Thrombectomy Registry data from January 2011 to December 2017. We identified patients with data on TC levels at baseline. TC values were categorized in three groups (reference group ⩾200 mg/dl). The two primary outcomes were any parenchymal hemorrhage (PH) and moderate to severe CED on follow up imaging. Secondary outcomes included death and functional independence (mRS 0–2) at 3 months. Multivariable logistic regression analysis adjusted for baseline factors including statin pretreatment was used to assess the association between TC levels and outcomes.Results: Of 35,314 patients with available information on TC levels at baseline, 3372 (9.5%) presented with TC levels ⩽130 mg/dl, 8203 (23.2%) with TC 130–200 mg/dl and 23,739 (67.3%) with TC ⩾ 200 mg/dl. In the adjusted analyses, TC level as continuous variable was inversely associated with moderate to severe CED (OR 0.99, 95% CI 0.99–1.00, p= 0.025) and as categorical variable lower TC levels were associated with a higher risk of moderate to severe CED (aOR 1.24, 95% CI 1.10–1.40, p= 0.003). TC levels were not associated with any PH, functional independence, and mortality at 3 months.Conclusions: Our findings indicate an independent association between low levels of TC and higher odds of moderate/severe CED. Further studies are needed to confirm these findings.

Published
2023
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157. Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants

Author

Meinel, Thomas R., Wilson, Duncan, Gensicke, Henrik, Scheitz, Jan F., Ringleb, Peter, Goganau, Ioana, Kaesmacher, Johannes, Bae, Hee-Joon, Kim, Do Yeon, Kermer, Pawel, Suzuki, Kentaro, Kimura, Kazumi, Macha, Kosmas, Koga, Masatoshi, Wada, Shinichi, Altersberger, Valerian, Salerno, Alexander, Palanikumar, Logesh, Zini, Andrea, Forlivesi, Stefano, Kellert, Lars, Wischmann, Johannes, Kristoffersen, Espen S., Beharry, James, Barber, P. Alan, Hong, Jae Beom, Cereda, Carlo, Schlemm, Eckhard, Yakushiji, Yusuke, Poli, Sven, Leker, Ronen, Romoli, Michele, Zedde, Marialuisa, Curtze, Sami, Ikenberg, Benno, Uphaus, Timo, Giannandrea, David, Portela, Pere Cardona, Veltkamp, Roland, Ranta, Annemarei, Arnold, Marcel, Fischer, Urs, Cha, Jae-Kwan, Wu, Teddy Y., Purrucker, Jan C., Seiffge, David J., Kägi, Georg, Engelter, Stefan, Nolte, Christian H., Kallmünzer, Bernd, Michel, Patrik, Kleinig, Timothy J., Fink, John, Rønning, Ole Morten, Campbell, Bruce, Nederkoorn, Paul J., Thomalla, Götz, Kunieda, Takenobu, Poli, Khouloud, Béjot, Yannick, Soo, Yannie, Garcia-Esperon, Carlos, Ntaios, Georges, Cordonnier, Charlotte, Marto, João Pedro, Bigliardi, Guido, Lun, François, Choi, Philip M. C., Steiner, Thorsten, Ustrell, Xavier, Werring, David, Wegener, Susanne, Pezzini, Alessandro, Du, Houwei, Martí-Fàbregas, Joan, Cánovas-Vergé, David, Strbian, Daniel, Padjen, Visnja, Yaghi, Shadi, Stretz, Christoph, and Kim, Joon-Tae

Abstract

IMPORTANCE: International guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC). OBJECTIVE: To determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion. DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021. EXPOSURES: Prior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation. MAIN OUTCOMES AND MEASURES: The main outcome was sICH within 36 hours after IVT, defined as worsening of at least 4 points on the National Institutes of Health Stroke Scale and attributed to radiologically evident intracranial hemorrhage. Outcomes were compared according to different selection strategies (DOAC-level measurements, DOAC reversal treatment, IVT with neither DOAC-level measurement nor idarucizumab). The association of sICH with DOAC plasma levels and very recent ingestions was explored in sensitivity analyses. RESULTS: Of 33 207 included patients, 14 458 (43.5%) were female, and the median (IQR) age was 73 (62-80) years. The median (IQR) National Institutes of Health Stroke Scale score was 9 (5-16). Of the 832 patients taking DOAC, 252 (30.3%) received DOAC reversal before IVT (all idarucizumab), 225 (27.0%) had DOAC-level measurements, and 355 (42.7%) received IVT without measuring DOAC plasma levels or reversal treatment. The unadjusted rate of sICH was 2.5% (95% CI, 1.6-3.8) in patients taking DOACs compared with 4.1% (95% CI, 3.9-4.4) in control patients using no anticoagulants. Recent DOAC ingestion was associated with lower odds of sICH after IVT compared with no anticoagulation (adjusted odds ratio, 0.57; 95% CI, 0.36-0.92). This finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion. CONCLUSIONS AND RELEVANCE: In this study, there was insufficient evidence of excess harm associated with off-label IVT in selected patients after ischemic stroke with recent DOAC ingestion.

Published
2023
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158. Endovascular vs Medical Management for Late Anterior Large Vessel Occlusion With Prestroke Disability

Author

Siegler, James E., Qureshi, Muhammad M., Nogueira, Raul G., Tanaka, Kanta, Nagel, Simon, Michel, Patrik, Vigilante, Nicholas, Ribo, Marc, Yamagami, Hiroshi, Yoshimura, Shinichi, Abdalkader, Mohamad, Haussen, Diogo C., Mohammaden, Mahmoud H., Nannoni, Stefania, Möhlenbruch, Markus A., Henon, Hilde, Sheth, Sunil A., Ortega-Gutierrez, Santiago, Olive-Gadea, Marta, Caparros, Francois, Seker, Fatih, Zaidi, Syed, Castonguay, Alicia C., Uchida, Kazutaka, Sakai, Nobuyuki, Puri, Ajit S., Farooqui, Mudassir, Toyoda, Kazunori, Salazar-Marioni, Sergio, Takeuchi, Masataka, Farzin, Behzad, Masoud, Hesham E., Kuhn, Anna Luisa, Rana, Ameena, Morimoto, Masafumi, Shibata, Masunari, Nonaka, Tadashi, Klein, Piers, Sathya, Anvitha, Kiley, Nicole L., Cordonnier, Charlotte, Strambo, Davide, Demeestere, Jelle, Ringleb, Peter A., Roy, Daniel, Zaidat, Osama O., Jovin, Tudor G., Kaesmacher, Johannes, Fischer, Urs, Raymond, Jean, and Nguyen, Thanh N.

Published
2023
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159. Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Author

Nguyen, Thanh N., Qureshi, Muhammad M., Klein, Piers, Yamagami, Hiroshi, Mikulik, Robert, Czlonkowska, Anna, Abdalkader, Mohamad, Sedova, Petra, Sathya, Anvitha, Lo, Hannah C., Mansour, Ossama Yassin, Vanguru, Husitha Reddy, Lesaine, Emilie, Tsivgoulis, Georgios, Loochtan, Aaron I., Demeestere, Jelle, Uchino, Ken, Inoa, Violiza, Goyal, Nitin, Charidimou, Andreas, Siegler, James E., Yaghi, Shadi, Aguiar de Sousa, Diana, Mohammaden, Mahmoud H., Haussen, Diogo C., Kristoffersen, Espen Saxhaug, Lereis, Virginia Pujol, Scollo, Sergio Daniel, Campbell, Bruce C. V., Ma, Alice, Thomas, James Orton, Parsons, Mark W., Singhal, Shaloo, Slater, Lee-Anne, Tomazini Martins, Rodrigo, Enzinger, Chris, Gattringer, Thomas, Rahman, Aminur, Bonnet, Thomas, Ligot, Noemie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C.T., de Oliveira Neves, Luciana, Martins, Rodrigo Targa, Mora Cuervo, Daissy Liliana, Rebello, Leticia C., Santiago, Igor Bessa, Lameirinhas da Silva, Isabelle, Sakelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Catanese, Luciana, Cora, Elena Adela, Goyal, Mayank, Hill, Michael D., Kelly, Michael E., Khosravani, Houman, Lavoie, Pascale, Peeling, Lissa, Pikula, Aleksandra, Rivera, Rodrigo, Chen, Hui-Sheng, Chen, Yimin, Huo, Xiaochuan, Miao, Zhongrong, Yang, Shuiquan, Bedekovic, Marina Roje, Bralic, Marina, Budincevic, Hrvoje, Corredor-Quintero, Angel Basilio, Lara-Sarabia, Osvaldo E., Cabal, Martin, Tenora, Dusan, Fibrich, Petr, Herzig, Roman, Hlaváčová, Helena, Hrabanovska, Emanuela, Hlinovsky, David, Jurak, Lubomir, Kadlcikova, Jana, Karpowicz, Igor, Klecka, Lukas, Kovar, Martin, Lauer, David, Neumann, Jiri, Palouskova, Hana, Reiser, Martin, Rekova, Petra, Rohan, Vladimir, Skoda, Ondrej, Škorňa, Miroslav, Sobotková, Lenka, Sramek, Martin, Zakova, Lenka, Christensen, Hanne, Drenck, Nicolas, Iversen, Helle Klingenberg, Truelsen, Thomas Clement, Wienecke, Troels, Sobh, Khalid, Ylikotila, Pauli, Alpay, Kemal, Strbian, Daniel, Bernady, Patricia, Casenave, Philippe, Dan, Maria, Faucheux, Jean-Marc, Gentric, Jean-Christophe, Magro, Elsa, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Bohmann, Ferdinand O., Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Nolte, Christian H., Ringleb, Peter A., Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, Jose Dominguo, Huded, Vikram, Menon, Bindu, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P.N., Krishna Pramana, Nyoman Angga, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Hokmabadi, Elyar Sadeghi, Raya, Tariq Abu, Kalmanovich, Shani Avnery, Ronen, Levite, Sabetay, Sergiu Ionut, Acampa, Maurizio, Adami, Alessandro, Castellan, Lucio, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Bigliani, Claudia Rolla, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Doijiri, Ryosuke, Fukuda, Hiroki, Fujinaka, Toshiyuki, Fujita, Kyohei, Imamura, Hirotoshi, Sakai, Nobuyuki, Kanamaru, Takuya, Kimura, Naoto, Kono, Ryuhei, Miyake, Kosuke, Sakaguchi, Manabu, Sakai, Kenichiro, Sonoda, Kazutaka, Todo, Kenichi, Miyashita, Fumio, Tokuda, Naoki, Matsumaru, Yuji, Matsumoto, Shoji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Yagita, Yoshiki, Yamada, Takehiro, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Waweru, Peter Kuria, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Sohn, Sung-Il, Arsovska, Anita Ante, Chan, Yong Chieh, Wan Zaidi, Wan Asyraf, Jaafar, Ainul Syahrilfazli, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Groppa, Stanislav, Leahu, Pavel, Coutinho, Jonathan M., Rinkel, Leon A., Dippel, Diederik W.J., van Dam-Nolen, Dianne H.K., Ranta, Annemarei, Wu, Teddy Y., Adebayo, Tajudeen Temitayo, Bello, Abiodun H., Nwazor, Ernest Okwundu, Sunmonu, Taofiki Ajao, Wahab, Kolawole Wasiu, Ronning, Ole Morten, Sandset, Else Charlotte, Al Hashmi, Amal M., Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Hao Dy, Jon Stewart, Pineda-Franks, Maria Carissa, Co, Christian Oliver, Brola, Waldemar, Debiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M., Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Sobolewski, Piotr, Wiacek, Marcin, Zielinska-Turek, Justyna, Araujo, Andre Pinho, Rocha, Mariana, Castro, Pedro, Cruz, Vitor Tedim, Ferreira, Paulo Venancio, Ferreira, Patricia, Nunes, Ana Paiva, Fonseca, Luisa, Marto, João Pedro, Pinho e Melo, Teresa, Rodrigues, Miguel, Silva, M. Luis, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Mako, Miroslav, Ayo-Martin, Oscar, Hernández-Fernández, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Perez-Sanchez, Soledad, García Sánchez, María Jesús, Guillán Rodríguez, Marta, Jood, Katarina, Nordanstig, Annika, Mazya, Michael V., Moreira, Tiago T.P., Bernava, Gianmarco, Beyeler, Morin, Bolognese, Manuel, Carrera, Emmanuel, Dobrocky, Tomas, Karwacki, Grzegorz Marek, Keller, Emanuela, Hsieh, Chang Yang, Boonyakarnkul, Surawan, Churojana, Anchalee, Aykac, Ozlem, Ozdemir, Atilla Özcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed Irteza, John, Seby, Banerjee, Soma, Kwan, Joseph, Krishnan, Kailash, Lenthall, Robert, Matthews, Ashok, Wong, Ken, Zhang, Liqun, Altschul, Dorothea, Asif, Kaiz S., Bahiru, Zeelalem, Below, Kristine, Biller, José, Ruland, Sean, Chaudry, Saqib A., Chen, Michael, Chebl, Alex, Cibulka, Jackie, Cistrunk, Leon, Clark, Judith, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam, D'Amato, Salvatore, Dharmadhikari, Sushrut, Grimmett, Kasey B., Dmytriw, Adam A., Etherton, Mark R., Ezepue, Chizoba, Farooqui, Mudassir, Feske, Steven K., Fink, Lauren, Gasimova, Ulviyya, Guzik, Amy K., Hakemi, Maryam, Hovingh, Majesta, Khan, Muhib, Jillela, Dinesh, Kan, Peter T., Khatri, Rakesh, Khawaja, Ayaz M., Khoury, Naim N., Kiley, Nicole L., Kim, Benny S., Kolikonda, Murali K., Kuhn, Anna Luisa, Lara, Stephanie, Linares, Guillermo, Linfante, Italo, Lukovits, Timothy G., Lycan, Sarah, Male, Shailesh S., Maali, Laith, Mancin, John, Masoud, Hesham, Mohamed, Ghada A., Monteiro, Andre, Nahab, Fadi, Nalleballe, Krishna, Ortega-Gutierrez, Santiago, Puri, Ajit S., Radaideh, Yazan, Rahangdale, Rahul H., Rai, Ansaar, Ramakrishnan, Pankajavalli, Reddy, Aravind B., Rojas-Soto, Diana M., Romero, Jose Rafael, Rost, Natalia S., Rothstein, Aaron, Omran, Setareh Salehi, Sheth, Sunil A., Siddiqui, Adnan H., Starosciak, Amy K., Tarlov, Nicholas E., Taylor, Robert A., Wang, Michael J., Wolfe, Jared, Wong, Ka-Ho, Le, Huynh Vu, Nguyen, Quy Viet, Pham, Thong Nhu, Nguyen, Trung Thanh, Phan, Hoang Thi, Ton, Mai Duy, Fischer, Urs, Michel, Patrik, Strambo, Davide, Martins, Sheila O., Zaidat, Osama O., and Nogueira, Raul G.

Published
2023
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160. Clinical value of automated volumetric quantification of early ischemic tissue changes on non-contrast CT

Author

Brugnara, Gianluca, Mihalicz, Peter, Herweh, Christian, Scho¨nenberger, Silvia, Purrucker, Jan, Nagel, Simon, Ringleb, Peter Arthur, Bendszus, Martin, Mo¨hlenbruch, Markus A, and Neuberger, Ulf

Abstract

BackgroundQuantitative and automated volumetric evaluation of early ischemic changes on non-contrast CT (NCCT) has recently been proposed as a new tool to improve prognostic performance in patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). We aimed to test its clinical value compared with the Alberta Stroke Program Early CT Score (ASPECTS) in a large single-institutional patient cohort.MethodsA total of 1103 patients with AIS due to large vessel occlusion in the M1 or proximal M2 segments who underwent NCCT and EVT between January 2013 and November 2019 were retrospectively enrolled. Acute ischemic volumes (AIV) and ASPECTS were generated from the baseline NCCT through e-ASPECTS (Brainomix). Correlations were tested using Spearman’s coefficient. The predictive capabilities of AIV for a favorable outcome (modified Rankin Scale score at 90 days ≤2) were tested using multivariable logistic regression as well as machine-learning models. Performance of the models was assessed using receiver operating characteristic (ROC) curves and differences were tested using DeLong’s test.ResultsPatients with a favorable outcome had a significantly lower AIV (median 12.0 mL (IQR 5.7–21.7) vs 18.8 mL (IQR 9.4–33.9), p<0.001). AIV was highly correlated with ASPECTS (rho=0.78, p<0.001) and weakly correlated with the National Institutes of Health Stroke Scale score at baseline (rho=0.22, p<0.001), and was an independent predictor of an unfavorable clinical outcome (adjusted OR 0.97, 95% CI 0.96 to 0.98). No significant difference was found between machine-learning models using either AIV or ASPECTS or both metrics for predicting a good clinical outcome (p>0.05).ConclusionAIV is an independent predictor of clinical outcome and presented a non-inferior performance compared with ASPECTS, without clear advantages for prognostic modelling.

Published
2023
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161. Comparison of susceptibility weighted imaging and TOF-angiography for the detection of Thrombi in acute stroke.

Author

Alexander Radbruch, Johanna Mucke, Ferdinand Schweser, Andreas Deistung, Peter Alexander Ringleb, Christian Herbert Ziener, Matthias Roethke, Heinz-Peter Schlemmer, Sabine Heiland, Jürgen R Reichenbach, Martin Bendszus, and Stefan Rohde

Subjects
Medicine, Science
Abstract

BACKGROUND AND PURPOSE: Time-of-flight (TOF) angiography detects embolic occlusion of arteries in patients with acute ischemic stroke due to the absence of blood flow in the occluded vessel. In contrast, susceptibility weighted imaging (SWI) directly enables intravascular clot visualization due to hypointense susceptibility vessel signs (SVS) in the occluded vessel. The aim of this study was to compare the diagnostic accuracy of both methods to determine vessel occlusion in patients with acute stroke. METHODS: 94 patients were included who presented with clinical symptoms for acute stroke and displayed a delay on the time-to-peak perfusion map in the territory of the anterior (ACA), middle (M1, M1/M2, M2/M3) or posterior (PCA) cerebral artery. The frequency of SVS on SWI and vessel occlusion or stenosis on TOF-angiography was compared using the McNemar-Test. RESULTS: 87 of 94 patients displayed a clearly definable SVS on SWI. In 72 patients the SVS was associated with occlusion or stenosis on TOF-angiography. Fifteen patients exclusively displayed SVS on SWI (14 M2/M3, 1 M1), whereas no patient revealed exclusively occlusion or stenosis on TOF-angiography. Sensitivity for detection of embolic occlusion within major vessel segments (M1, M1/M2, ACA, and PCA) did not show any significant difference between both techniques (97% for SWI versus 96% for TOF-angiography) while the sensitivity for detection of embolic occlusion within M2/M3 was significantly different (84% for SWI versus 39% for TOF-angiography, p

Published
2013
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167. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis.

Author

Kuramatsu, Joji B., Gerner, Stefan T., Ziai, Wendy, Bardutzky, Jürgen, Sembill, Jochen A., Sprügel, Maximilian I., Mrochen, Anne, Kölbl, Kathrin, Ram, Malathi, Avadhani, Radhika, Falcone, Guido J., Selim, Magdy H., Lioutas, Vasileios-Arsenios, Endres, Matthias, Zweynert, Sarah, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Volkmann, Jens, and Neugebauer, Hermann

Published
2022
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171. Intravenous alteplase for unknown time of onset stroke guided by advanced imaging: a systematic review and meta-analysis of individual patient data

Author

Thomalla, G., Boutitie, F., Ma, H., Koga, M., Ringleb, P., Schwamm, L.H., Wu, O., Bendszus, M., Bladin, C.F., Campbell, B.C.V., Cheng, B., Churilov, L., Ebinger, M., Endres, M., Fiebach, J.B., Fukuda-Doi, M., Inoue, M., Kleinig, T.J., Latour, L.L., Lemmens, R., Levi, C.R., Leys, D., Miwa, K., Molina, C., Muir, K.W., Nighoghossian, N., Parsons, M.W., Pedraza, S., Schellinger, P., Schwab, S., Simonsen, C.Z., Song, S.S., Thijs, V., Toni, D., Hsu, C., Wahlgren, N., Yamamoto, H., Yassi, N., Yoshimura, S., Warach, S., Hacke, W., Toyoda, K., Donnan, G.A., Davis, S.M., and Gerloff, C.

Abstract

Background: \ud Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers.\ud \ud Methods: \ud We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903.\ud \ud Findings: \ud Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [

Published
2020

184. Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion

Author

Seker, Fatih, Qureshi, Muhammad M., Möhlenbruch, Markus A., Nogueira, Raul G., Abdalkader, Mohamad, Ribo, Marc, Caparros, Francois, Haussen, Diogo C., Mohammaden, Mahmoud H., Sheth, Sunil A., Ortega-Gutierrez, Santiago, Siegler, James E., Zaidi, Syed F., Olive-Gadea, Marta, Henon, Hilde, Castonguay, Alicia C., Nannoni, Stefania, Kaesmacher, Johannes, Puri, Ajit S., Farooqui, Mudassir, Salazar-Marioni, Sergio, Kuhn, Anna L., Kiley, Nicole L., Farzin, Behzad, Boisseau, William, Masoud, Hesham E., Lopez, Carlos Ynigo, Rana, Ameena, Abdul Kareem, Samer, Sathya, Anvitha, Klein, Piers, Kassem, Mohammad W., Cordonnier, Charlotte, Gralla, Jan, Fischer, Urs, Michel, Patrik, Strambo, Davide, Jovin, Tudor G., Raymond, Jean, Zaidat, Osama O., Ringleb, Peter A., Nguyen, Thanh N., and Nagel, Simon

Published
2022
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185. Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration

Author

Altersberger, Valerian L., Rusche, Norman, Martinez-Majander, Nicolas, Hametner, Christian, Scheitz, Jan F., Henon, Hilde, Dell’Acqua, Maria Luisa, Strambo, Davide, Stolp, Jeffrey, Heldner, Mirjam R., Grisendi, Ilaria, Jovanovic, Dejana R., Bejot, Yannick, Pezzini, Alessandro, Leker, Ronen R., Kägi, Georg, Wegener, Susanne, Cereda, Carlo W., Lindgren, Erik, Ntaios, George, Piot, Ines, Polymeris, Alexandros A., Lyrer, Philippe A., Räty, Silja, Sibolt, Gerli, Tiainen, Marjaana, Heyse, Miriam, Erdur, Hebun, Kaaouana, Olfa, Padjen, Visnja, Zedde, Marialuisa, Arnold, Marcel, Nederkoorn, Paul J., Michel, Patrik, Bigliardi, Guido, Zini, Andrea, Cordonnier, Charlotte, Nolte, Christian H., Ringleb, Peter A., Curtze, Sami, Engelter, Stefan T., and Gensicke, Henrik

Published
2022
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188. Ischaemic Stroke and Transient Ischaemic Attack

Author

Ringleb, P. A., primary, Bousser, M.-G., additional, Ford, G., additional, Bath, P., additional, Brainin, M., additional, Caso, V., additional, Cervera, Á., additional, Chamorro, A.l, additional, Cordonnier, Charlotte, additional, Csiba, L., additional, Davalos, A., additional, Diener, H.-C., additional, Ferro, J., additional, Hacke, W., additional, Hennerici, M., additional, Kaste, M., additional, Langhorne, P., additional, Lees, K., additional, Leys, D., additional, Lodder, J., additional, Markus, H. S., additional, Mas, J.-L., additional, Mattle, H. P., additional, Muir, K., additional, Norrving, B., additional, Obach, V., additional, Paolucci, S., additional, Ringelstein, E. B., additional, Schellinger, P. D., additional, Sivenius, J., additional, Skvortsova, V., additional, Sunnerhagen, K. Stibrant, additional, Thomassen, L., additional, Toni, D., additional, Kummer, R.r von, additional, Wahlgren, N. Gunnar, additional, Walker, M. F., additional, and Wardlaw, J., additional

Published
2010
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198. IV THROMBOLYSIS AND STATINS: 15

Author

Engelter, S. T., Soinne, L., Ringleb, P., Sarikaya, H., Berrouschot, J., Odier, C., Arnold, M., Ford, G. A., Pezzini, A., Zini, A., Bonati, L. H., Michel, P., Leys, D., Tatlisumak, T., and Lyrer, P. A.

Published
2011

200. The Incidence and Associated Factors of Early Neurological Deterioration After Thrombolysis

Author

Yu, Wai M., primary, Abdul-Rahim, Azmil H., additional, Cameron, Alan C., additional, Kõrv, Janika, additional, Sevcik, Petr, additional, Toni, Danilo, additional, Lees, Kennedy R., additional, Wahlgren, N., additional, Ahmed, N., additional, Caso, V., additional, Roffe, C., additional, Kobayashi, A., additional, Tsivgoulis, G., additional, Toni, D., additional, Ford, G.A., additional, Lees, K.R., additional, and Ringleb, P., additional

Published
2020
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