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2. Thrombolysis for Wake-Up Stroke Versus Non–Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis

Author

Kamogawa, Naruhiko, Miwa, Kaori, Toyoda, Kazunori, Jensen, Märit, Inoue, Manabu, Yoshimura, Sohei, Fukuda-Doi, Mayumi, Kitazono, Takanari, Boutitie, Florent, Ma, Henry, Ringleb, Peter, Wu, Ona, Schwamm, Lee H., Warach, Steven, Hacke, Werner, Davis, Stephen M., Donnan, Geoffrey A., Gerloff, Christian, Thomalla, Götz, Koga, Masatoshi, Cheng, Bastian, Bendszus, Martin, Bladin, Christopher, Churilov, Leonid, Campbell, Brunce, Parsons, Mark, Yassi, Nawaf, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B., Kleinig, Timothy, Latour, Lawrence, Lemmens, Robin, Levi, Christopher, Leys, Didier, Molina, Carlos, Muir, Keith, Nighoghossian, Norbert, Pedraza, Salvador, Schellinger, Peter D., Schwab, Stefan, Simonsen, Claus Z., Song, Shlee S., Thijs, Vincent, Toni, Danilo, Hsu, Chung Y., and Wahlgren, Nils

Published
2024
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6. Magnetic Resonance Imaging–Guided Thrombolysis (0.6 mg/kg) Was Beneficial for Unknown Onset Stroke Above a Certain Core Size: THAWS RCT Substudy

Author

Toyoda, Kazunori, Inoue, Manabu, Yoshimura, Sohei, Yamagami, Hiroshi, Sasaki, Makoto, Fukuda-Doi, Mayumi, Kimura, Kazumi, Asakura, Koko, Miwa, Kaori, Kanzawa, Takao, Ihara, Masafumi, Kondo, Rei, Shiozawa, Masayuki, Ohtaki, Masafumi, Kamiyama, Kenji, Itabashi, Ryo, Iwama, Toru, Aoki, Junya, Minematsu, Kazuo, Yamamoto, Haruko, and Koga, Masatoshi

Published
2021
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7. Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes with Alteplase at 0.6 mg/kg in Clinical Practice: THAWS2 Study.

Author

Yoshimura, Sohei, Koga, Masatoshi, Okada, Takashi, Inoue, Manabu, Miwa, Kaori, Fukuda-Doi, Mayumi, Kondo, Rei, Inoue, Takeshi, Ichijo, Masahiko, Ohtaki, Masafumi, Nagakane, Yoshinari, Itabashi, Ryo, Sakai, Nobuyuki, Kimura, Kazumi, Kamiyama, Kenji, Shiokawa, Yoshiaki, Yagita, Yoshiki, Iwama, Toru, Yakushiji, Yusuke, and Kusumi, Masayoshi

Subjects
THROMBOLYTIC therapy, ISCHEMIC stroke, STROKE patients, ALTEPLASE, INTRACRANIAL hemorrhage
Abstract

Introduction: The aim of this study was to determine the safety and efficacy of intravenous (IV) alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice. Methods: This multicenter observational study enrolled acute ischemic stroke patients with last-known-well time >4.5 h who had mismatch between DWI and FLAIR and were treated with IV alteplase. The safety outcomes were symptomatic intracranial hemorrhage (sICH) after thrombolysis, all-cause deaths, and all adverse events. The efficacy outcomes were favorable outcome defined as an mRS score of 0–1 or recovery to the same mRS score as the premorbid score, complete independence defined as an mRS score of 0–1 at 90 days, and change in NIHSS at 24 h from baseline. Results: Sixty-six patients (35 females; mean age, 74 ± 11 years; premorbid complete independence, 54 [82%]; median NIHSS on admission, 11) were enrolled at 15 hospitals. Two patients (3%) had sICH. Median NIHSS changed from 11 (IQR, 6.75–16.25) at baseline to 5 (3–12.25) at 24 h after alteplase initiation (change, −4.8 ± 8.1). At discharge, 31 patients (47%) had favorable outcome and 29 (44%) had complete independence. None died within 90 days. Twenty-three (35%) also underwent mechanical thrombectomy (no sICH, NIHSS change of −8.5 ± 7.3), of whom 11 (48%) were completely independent at discharge. Conclusions: In real-world clinical practice, IV alteplase for unclear-onset stroke patients with DWI-FLAIR mismatch provided safe and efficacious outcomes comparable to those in previous trials. Additional mechanical thrombectomy was performed safely in them. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Thrombolysis With Alteplase at 0.6 mg/kg for Stroke With Unknown Time of Onset: A Randomized Controlled Trial

Author

Koga, Masatoshi, Yamamoto, Haruko, Inoue, Manabu, Asakura, Koko, Aoki, Junya, Hamasaki, Toshimitsu, Kanzawa, Takao, Kondo, Rei, Ohtaki, Masafumi, Itabashi, Ryo, Kamiyama, Kenji, Iwama, Toru, Nakase, Taizen, Yakushiji, Yusuke, Igarashi, Shuichi, Nagakane, Yoshinari, Takizawa, Shunya, Okada, Yasushi, Doijiri, Ryosuke, Tsujino, Akira, Ito, Yasuhiro, Ohnishi, Hideyuki, Inoue, Takeshi, Takagi, Yasushi, Hasegawa, Yasuhiro, Shiokawa, Yoshiaki, Sakai, Nobuyuki, Osaki, Masato, Uesaka, Yoshikazu, Yoshimura, Shinichi, Urabe, Takao, Ueda, Toshihiro, Ihara, Masafumi, Kitazono, Takanari, Sasaki, Makoto, Oita, Akira, Yoshimura, Sohei, Fukuda-Doi, Mayumi, Miwa, Kaori, Kimura, Kazumi, Minematsu, Kazuo, and Toyoda, Kazunori

Published
2020
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10. Abstract TMP2: Intravenous Thrombolysis For Ischemic Stroke With Unknown Time Of Onset: Differences Between Wake-up Stroke And Non-wake-up Subtypes: EOS

Author

Naruhiko, Kamogawa, primary, Miwa, Kaori, additional, Koga, Masatoshi, additional, Märit, Jensen, additional, Inoue, Manabu, additional, Yoshimura, Sohei, additional, Fukuda-Doi, Mayumi, additional, Ma, Henry, additional, Ringleb, Peter, additional, Wu, Ona, additional, Schwamm, Lee H, additional, Davis, Stephen, additional, Donnan, Geoffrey A, additional, Gerloff, Christian P, additional, Thomalla, Götz, additional, and Toyoda, Kazunori, additional

Published
2023
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11. Sequential Detection Rates of Intramural Hematoma for Diagnosing Spontaneous Intracranial Artery Dissection

Author

Hosoki, Satoshi, primary, Fukuda‐Doi, Mayumi, additional, Miwa, Kaori, additional, Yoshimura, Sohei, additional, Morita, Yoshiaki, additional, Chiba, Tetsuya, additional, Noda, Kotaro, additional, Yamaguchi, Yoshitaka, additional, Ikenouchi, Hajime, additional, Makita, Naoki, additional, Mizoguchi, Tadataka, additional, Nakamura, Yuki, additional, Satow, Tetsu, additional, Kataoka, Hiroharu, additional, Toyoda, Kazunori, additional, Ihara, Masafumi, additional, and Koga, Masatoshi, additional

Published
2023
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12. Intravenous Alteplase at 0.6 mg/kg for Unknown Onset Stroke with Prior Antithrombotic Medication: THAWS Randomized Clinical Trial

Author

Koga, Masatoshi, primary, Inoue, Manabu, additional, Miwa, Kaori, additional, Yoshimura, Sohei, additional, Fukuda-Doi, Mayumi, additional, Aoki, Junya, additional, Asakura, Koko, additional, Kanzawa, Takao, additional, Ohtaki, Masafumi, additional, Kamiyama, Kenji, additional, Yakushiji, Yusuke, additional, Igarashi, Shuichi, additional, Doijiri, Ryosuke, additional, Ito, Yasuhiro, additional, Takagi, Yasushi, additional, Sasaki, Makoto, additional, Kitazono, Takanari, additional, Kimura, Kazumi, additional, Minematsu, Kazuo, additional, Yamamoto, Haruko, additional, and Toyoda, Kazunori, additional

Published
2023
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13. IC methods in acute stroke trials-ascoping review

Author

Ishigami, Akiko, Inoue, Manabu, Yamaguchi, Eriko, Fukuda-Doi, Mayumi, Toyoda, Kazunori, Yoshimura, Sohei, and Koga, Masatoshi

Subjects
Stroke, Informed concent, waivers of concent, EFIC, Medicine and Health Sciences, Clinical Trials
Abstract

In clinical trials for hyperacute stroke treatment, obtaining timely and appropriate consent from participants is a major challenge in order to deliver effective therapeutic interventions within the limited therapeautic time window. This scoping review maps the method and strategy of obtaining consent from participants, including EFIC, in recent acute stroke trials as well as other clinical trials in emergency settings. The purpose of our reserch is to find appropriate procedures for obtaining consent in acute stroke trials, by understand the barriers in obtaining consent and how to address it.

Published
2023
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14. Alteplase for Stroke With Unknown Onset Time in Chronic Kidney Disease: A Pooled Analysis of Individual Participant Data

Author

Miwa, Kaori, primary, Koga, Masatoshi, additional, Jensen, Märit, additional, Inoue, Manabu, additional, Yoshimura, Sohei, additional, Fukuda-Doi, Mayumi, additional, Boutitie, Florent, additional, Ma, Henry, additional, Ringleb, Peter A., additional, Wu, Ona, additional, Schwamm, Lee H., additional, Warach, Steven, additional, Hacke, Werner, additional, Davis, Stephen M., additional, Donnan, Geoffrey A., additional, Gerloff, Christian, additional, Thomalla, Götz, additional, Toyoda, Kazunori, additional, Cheng, Bastian, additional, Bendszus, Martin, additional, Bladin, Christopher, additional, Churilov, Leonid, additional, Campbell, Brunce, additional, Parsons, Mark, additional, Yassi, Nawaf, additional, Ebinger, Martin, additional, Endres, Matthias, additional, Fiebach, Jochen B., additional, Kleinig, Timothy, additional, Latour, Lawrence, additional, Lemmens, Robin, additional, Levi, Christopher, additional, Leys, Didier, additional, Molina, Carlos, additional, Muir, Keith, additional, Nighoghossian, Norbert, additional, Pedraza, Salvador, additional, Schellinger, Peter D., additional, Schwab, Stefan, additional, Simonsen, Claus Z., additional, Song, Shlee S., additional, Thijs, Vincent, additional, Toni, Danilo, additional, Hsu, Chung Y., additional, and Wahlgren, Nils, additional

Published
2022
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15. sj-pdf-1-wso-10.1177_17474930211044635 - Supplemental material for Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review

Author

Toyoda, Kazunori, Yoshimura, Sohei, Fukuda-Doi, Mayumi, Qureshi, Adnan I, Martin, Renee��� Hebert, Palesch, Yuko Y, Ihara, Masafumi, Suarez, Jose I, Okada, Yasushi, Hsu, Chung Y, Itabashi, Ryo, Wang, Yongjun, Yamagami, Hiroshi, Steiner, Thorsten, Sakai, Nobuyuki, Yoon, Byung-Woo, Inoue, Manabu, Minematsu, Kazuo, Yamamoto, Haruko, and Koga, Masatoshi

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-wso-10.1177_17474930211044635 for Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review by Kazunori Toyoda, Sohei Yoshimura, Mayumi Fukuda-Doi, Adnan I Qureshi, Renee��� Hebert Martin, Yuko Y Palesch, Masafumi Ihara, Jose I Suarez, Yasushi Okada, Chung Y Hsu, Ryo Itabashi, Yongjun Wang, Hiroshi Yamagami, Thorsten Steiner, Nobuyuki Sakai, Byung-Woo Yoon, Manabu Inoue, Kazuo Minematsu, Haruko Yamamoto, Masatoshi Koga and the ATACH Trial Investigators and the SAMURAI Investigators in International Journal of Stroke

Published
2022
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17. Tenecteplase versus alteplase for large vessel occlusion recanalization (T-FLAVOR): Trial protocol

Author

Kawano, Hiroyuki, primary, Hirano, Teruyuki, additional, Inoue, Manabu, additional, Fukuda-Doi, Mayumi, additional, Iwasaki, Koji, additional, Omae, Katsuhiro, additional, Tanaka, Kanta, additional, Yamamoto, Haruko, additional, Koga, Masatoshi, additional, Sakai, Nobuyuki, additional, Nagao, Takehiko, additional, Sasaki, Makoto, additional, Hayakawa, Naoki, additional, and Toyoda, Kazunori, additional

Published
2022
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19. Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial

Author

Miwa, Kaori, primary, Koga, Masatoshi, additional, Inoue, Manabu, additional, Yoshimura, Sohei, additional, Sasaki, Makoto, additional, Yakushiji, Yusuke, additional, Fukuda-Doi, Mayumi, additional, Okada, Yasushi, additional, Nakase, Taizen, additional, Ihara, Masafumi, additional, Nagakane, Yoshinari, additional, Takizawa, Shunya, additional, Asakura, Koko, additional, Aoki, Junya, additional, Kimura, Kazumi, additional, Yamamoto, Haruko, additional, and Toyoda, Kazunori, additional

Published
2021
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20. sj-pdf-1-wso-10.1177_17474930211035023 - Supplemental material for Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial

Author

Miwa, Kaori, Koga, Masatoshi, Inoue, Manabu, Yoshimura, Sohei, Sasaki, Makoto, Yakushiji, Yusuke, Fukuda-Doi, Mayumi, Okada, Yasushi, Nakase, Taizen, Ihara, Masafumi, Nagakane, Yoshinari, Takizawa, Shunya, Asakura, Koko, Aoki, Junya, Kimura, Kazumi, Yamamoto, Haruko, and Toyoda, Kazunori

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-wso-10.1177_17474930211035023 for Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial by Kaori Miwa, Masatoshi Koga, Manabu Inoue, Sohei Yoshimura, Makoto Sasaki, Yusuke Yakushiji, Mayumi Fukuda-Doi, Yasushi Okada, Taizen Nakase, Masafumi Ihara, Yoshinari Nagakane, Shunya Takizawa, Koko Asakura, Junya Aoki, Kazumi Kimura, Haruko Yamamoto and Kazunori Toyoda in International Journal of Stroke

Published
2021
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21. Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial.

Author

Miwa, Kaori, Koga, Masatoshi, Inoue, Manabu, Yoshimura, Sohei, Sasaki, Makoto, Yakushiji, Yusuke, Fukuda-Doi, Mayumi, Okada, Yasushi, Nakase, Taizen, Ihara, Masafumi, Nagakane, Yoshinari, Takizawa, Shunya, Asakura, Koko, Aoki, Junya, Kimura, Kazumi, Yamamoto, Haruko, and Toyoda, Kazunori

Subjects
THROMBOLYTIC therapy, ISCHEMIC stroke, SECONDARY analysis, CEREBRAL small vessel diseases, CLINICAL trials
Abstract

Background and aim: We determined to investigate the incidence and clinical impact of new cerebral microbleeds after intravenous thrombolysis in patients with acute stroke. Methods: The THAWS was a multicenter, randomized trial to study the efficacy and safety of intravenous thrombolysis with alteplase in patients with wake-up stroke or unknown onset stroke. Prescheduled T2*-weighted imaging assessed cerebral microbleeds at three time points: baseline, 22–36 h, and 7–14 days. Outcomes included new cerebral microbleeds development, modified Rankin Scale (mRS) ≥3 at 90 days, and change in the National Institutes of Health Stroke Scale (NIHSS) score from 24 h to 7 days. Results: Of all 131 patients randomized in the THAWS trial, 113 patients (mean 74.3 ± 12.6 years, 50 female, 62 allocated to intravenous thrombolysis) were available for analysis. Overall, 46 (41%) had baseline cerebral microbleeds (15 strictly lobar cerebral microbleeds, 14 mixed cerebral microbleeds, and 17 deep cerebral microbleeds). New cerebral microbleeds only emerged in the intravenous thrombolysis group (seven patients, 11%) within a median of 28.3 h, and did not additionally increase within a median of 7.35 days. In adjusted models, number of cerebral microbleeds (relative risk (RR) 1.30, 95% confidence interval (CI): 1.17–1.44), mixed distribution (RR 19.2, 95% CI: 3.94–93.7), and cerebral microbleeds burden ≥5 (RR 44.9, 95% CI: 5.78–349.8) were associated with new cerebral microbleeds. New cerebral microbleeds were associated with an increase in NIHSS score (p = 0.023). Treatment with alteplase in patients with baseline ≥5 cerebral microbleeds resulted in a numerical shift toward worse outcomes on ordinal mRS (median [IQR]; 4 [3–4] vs. 0 [0–3]), compared with those with <5 cerebral microbleeds (common odds ratio 17.1, 95% CI: 0.76–382.8). The association of baseline ≥5 cerebral microbleeds with ordinal mRS score differed according to the treatment group (p interaction = 0.042). Conclusion: New cerebral microbleeds developed within 36 h in 11% of the patients after intravenous thrombolysis, and they were significantly associated with mixed-distribution and ≥5 cerebral microbleeds. New cerebral microbleeds development might impede neurological improvement. Furthermore, cerebral microbleeds burden might affect the effect of alteplase. [ABSTRACT FROM AUTHOR]

Published
2022
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22. Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review.

Author

Toyoda, Kazunori, Yoshimura, Sohei, Fukuda-Doi, Mayumi, Qureshi, Adnan I, Martin, Renee' Hebert, Palesch, Yuko Y, Ihara, Masafumi, Suarez, Jose I, Okada, Yasushi, Hsu, Chung Y, Itabashi, Ryo, Wang, Yongjun, Yamagami, Hiroshi, Steiner, Thorsten, Sakai, Nobuyuki, Yoon, Byung-Woo, Inoue, Manabu, Minematsu, Kazuo, Yamamoto, Haruko, and Koga, Masatoshi

Subjects
BLOOD pressure, CEREBRAL hemorrhage, SYSTOLIC blood pressure, COMPUTED tomography, INTRAVENOUS therapy
Abstract

Background and aims: Nicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined. Methods: A systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase ≥6 mL from baseline to 24-h computed tomography. Summary of review: Three studies met the eligibility criteria. For 1265 patients enrolled (age 62.6 ± 13.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00–1.26 per 10 mmHg) and hematoma expansion (1.16, 1.02–1.32). Mean hourly systolic blood pressure from 1 h to any timepoint during the initial 24 h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140 mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00–1.05 per hour). Conclusions: Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events. [ABSTRACT FROM AUTHOR]

Published
2022
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23. Abstract MP6: Thrombolysis for Acute Wake-Up And Unclear Onset Strokes With Alteplase at 0.6mg /kg in Clinical Practice: THAWS2 Study

Author

Yoshimura, Sohei, primary, Koga, Masatoshi, additional, Okada, Takashi, additional, Inoue, Manabu, additional, Miwa, Kaori, additional, Fukuda-doi, Mayumi, additional, Kondo, Rei, additional, Inoue, Takeshi, additional, Ichijo, Masahiko, additional, Ohtaki, Masafumi, additional, Nagakane, Yoshinari, additional, Itabashi, Ryo, additional, Sakai, Nobuyuki, additional, Aoki, Junya, additional, Shiokawa, Yoshiaki, additional, Yagita, Yoshiki, additional, Iwama, Toru, additional, Yakushiji, Yusuke, additional, Kusumi, Masayoshi, additional, Kamiyama, Kenji, additional, Doijiri, Ryosuke, additional, Igarashi, Shuichi, additional, Kanzawa, Takao, additional, Matsumoto, Shoji, additional, Ito, Yasuhiro, additional, Yoshimura, Shinichi, additional, Ohsaki, Masato, additional, Ihara, Masafumi, additional, and Toyoda, Kazunori, additional

Published
2021
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24. Abstract P7: Prior Antithrombotic Medication May Affect Outcomes Following Alteplase at 0.6mg for Unknown Onset Stroke: THAWS Randomized Clinical Trial

Author

Koga, Masatoshi, primary, Inoue, Manabu, additional, Miwa, Kaori, additional, Yoshimura, Sohei, additional, Fukuda-doi, Mayumi, additional, Aoki, Junya, additional, Asakura, Koko, additional, Ohtaki, Masafumi, additional, Kamiyama, Kenji, additional, Igarashi, Shuichi, additional, Doijiri, Ryosuke, additional, Ito, Yasuhiro, additional, Takagi, Yasushi, additional, Ihara, Masafumi, additional, Sasaki, Makoto, additional, Kitazono, Takanari, additional, Kimura, Kazumi, additional, Minematsu, Kazuo, additional, Yamamoto, Haruko, additional, and Toyoda, Kazunori, additional

Published
2021
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25. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data.

Author

UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Thomalla, Götz, Boutitie, Florent, Ma, Henry, Koga, Masatoshi, Ringleb, Peter, Schwamm, Lee H, Wu, Ona, Bendszus, Martin, Bladin, Christopher F, Campbell, Bruce C V, Cheng, Bastian, Churilov, Leonid, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B, Fukuda-Doi, Mayumi, Inoue, Manabu, Kleinig, Timothy J, Latour, Lawrence L, Lemmens, Robin, Levi, Christopher R, Leys, Didier, Miwa, Kaori, Molina, Carlos A, Muir, Keith W, Nighoghossian, Norbert, Parsons, Mark W, Pedraza, Salvador, Schellinger, Peter D, Schwab, Stefan, Simonsen, Claus Z, Song, Shlee S, Thijs, Vincent, Toni, Danilo, Hsu, Chung Y, Wahlgren, Nils, Yamamoto, Haruko, Yassi, Nawaf, Yoshimura, Sohei, Warach, Steven, Hacke, Werner, Toyoda, Kazunori, Donnan, Geoffrey A, Davis, Stephen M, Gerloff, Christian, Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators, Vandermeeren, Yves, UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Thomalla, Götz, Boutitie, Florent, Ma, Henry, Koga, Masatoshi, Ringleb, Peter, Schwamm, Lee H, Wu, Ona, Bendszus, Martin, Bladin, Christopher F, Campbell, Bruce C V, Cheng, Bastian, Churilov, Leonid, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B, Fukuda-Doi, Mayumi, Inoue, Manabu, Kleinig, Timothy J, Latour, Lawrence L, Lemmens, Robin, Levi, Christopher R, Leys, Didier, Miwa, Kaori, Molina, Carlos A, Muir, Keith W, Nighoghossian, Norbert, Parsons, Mark W, Pedraza, Salvador, Schellinger, Peter D, Schwab, Stefan, Simonsen, Claus Z, Song, Shlee S, Thijs, Vincent, Toni, Danilo, Hsu, Chung Y, Wahlgren, Nils, Yamamoto, Haruko, Yassi, Nawaf, Yoshimura, Sohei, Warach, Steven, Hacke, Werner, Toyoda, Kazunori, Donnan, Geoffrey A, Davis, Stephen M, Gerloff, Christian, Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators, and Vandermeeren, Yves

Abstract

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. 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. 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 (I=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

Published
2020

26. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging:systematic review and meta-analysis of individual patient data

Author

Thomalla, Götz, Boutitie, Florent, Ma, Henry, Koga, Masatoshi, Ringleb, Peter, Schwamm, Lee H., Wu, Ona, Bendszus, Martin, Bladin, Christopher F., Campbell, Bruce C.V., Cheng, Bastian, Churilov, Leonid, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B., Fukuda-Doi, Mayumi, Inoue, Manabu, Kleinig, Timothy J., Latour, Lawrence L., Lemmens, Robin, Levi, Christopher R., Leys, Didier, Miwa, Kaori, Molina, Carlos A., Muir, Keith W., Nighoghossian, Norbert, Parsons, Mark W., Pedraza, Salvador, Schellinger, Peter D., Schwab, Stefan, Simonsen, Claus Z., Song, Shlee S., Thijs, Vincent, Toni, Danilo, Hsu, Chung Y., Wahlgren, Nils, Aegidius, Karen, Christensen, Hanne, Iversen, Helle, Kemmling, André, Khan, Usman, Marstrand, Jacob, Meden, Per, Møller, Anette, Truelsen, Thomas, Van Hooff, Robbert Jan, Vestergaard, Karsten, Anderson, C., Chang, W. H., Steiner, Thorsten, Thomalla, Götz, Boutitie, Florent, Ma, Henry, Koga, Masatoshi, Ringleb, Peter, Schwamm, Lee H., Wu, Ona, Bendszus, Martin, Bladin, Christopher F., Campbell, Bruce C.V., Cheng, Bastian, Churilov, Leonid, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B., Fukuda-Doi, Mayumi, Inoue, Manabu, Kleinig, Timothy J., Latour, Lawrence L., Lemmens, Robin, Levi, Christopher R., Leys, Didier, Miwa, Kaori, Molina, Carlos A., Muir, Keith W., Nighoghossian, Norbert, Parsons, Mark W., Pedraza, Salvador, Schellinger, Peter D., Schwab, Stefan, Simonsen, Claus Z., Song, Shlee S., Thijs, Vincent, Toni, Danilo, Hsu, Chung Y., Wahlgren, Nils, Aegidius, Karen, Christensen, Hanne, Iversen, Helle, Kemmling, André, Khan, Usman, Marstrand, Jacob, Meden, Per, Møller, Anette, Truelsen, Thomas, Van Hooff, Robbert Jan, Vestergaard, Karsten, Anderson, C., Chang, W. H., and Steiner, Thorsten

Abstract

Background: 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. Methods: 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. Findings: 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

Published
2020

28. Regional differences in the response to acute blood pressure lowering after cerebral hemorrhage

Author

Toyoda, Kazunori, primary, Palesch, Yuko Y, additional, Koga, Masatoshi, additional, Foster, Lydia, additional, Yamamoto, Haruko, additional, Yoshimura, Sohei, additional, Ihara, Masafumi, additional, Fukuda-Doi, Mayumi, additional, Okazaki, Shuhei, additional, Tanaka, Kanta, additional, Miwa, Kaori, additional, Hasegawa, Yasuhiro, additional, Shiokawa, Yoshiaki, additional, Iwama, Toru, additional, Kamiyama, Kenji, additional, Hoshino, Haruhiko, additional, Steiner, Thorsten, additional, Yoon, Byung-Woo, additional, Wang, Yongjun, additional, Hsu, Chung Y, additional, and Qureshi, Adnan I, additional

Published
2020
Full Text
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29. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Author

Thomalla, Götz, primary, Boutitie, Florent, additional, Ma, Henry, additional, Koga, Masatoshi, additional, Ringleb, Peter, additional, Schwamm, Lee H, additional, Wu, Ona, additional, Bendszus, Martin, additional, Bladin, Christopher F, additional, Campbell, Bruce C V, additional, Cheng, Bastian, additional, Churilov, Leonid, additional, Ebinger, Martin, additional, Endres, Matthias, additional, Fiebach, Jochen B, additional, Fukuda-Doi, Mayumi, additional, Inoue, Manabu, additional, Kleinig, Timothy J, additional, Latour, Lawrence L, additional, Lemmens, Robin, additional, Levi, Christopher R, additional, Leys, Didier, additional, Miwa, Kaori, additional, Molina, Carlos A, additional, Muir, Keith W, additional, Nighoghossian, Norbert, additional, Parsons, Mark W, additional, Pedraza, Salvador, additional, Schellinger, Peter D, additional, Schwab, Stefan, additional, Simonsen, Claus Z, additional, Song, Shlee S, additional, Thijs, Vincent, additional, Toni, Danilo, additional, Hsu, Chung Y, additional, Wahlgren, Nils, additional, Yamamoto, Haruko, additional, Yassi, Nawaf, additional, Yoshimura, Sohei, additional, Warach, Steven, additional, Hacke, Werner, additional, Toyoda, Kazunori, additional, Donnan, Geoffrey A, additional, Davis, Stephen M, additional, Gerloff, Christian, additional, Acosta, Boris Raul, additional, Aegidius, Karen, additional, Albiker, Christian, additional, Alegiani, Anna, additional, Almendrote, Miriam, additional, Alonso, Angelika, additional, Althaus, Katharina, additional, Amarenco, Pierre, additional, Amiri, Hemasse, additional, Anders, Bettina, additional, Aniculaesei, Adriana, additional, Appleton, Jason, additional, Arenillas, Juan, additional, Back, Christina, additional, Bähr, Christian, additional, Bardutzky, Jürgen, additional, Baronnet-Chauvet, Flore, additional, Bathe-Peters, Rouven, additional, Bayer-Karpinska, Anna, additional, Becerra, Juan L., additional, Beck, Christoph, additional, Belchí Guillamon, Olga, additional, Benoit, Amandine, additional, Berhoune, Nadia, additional, Bindila, Daniela, additional, Birchenall, Julia, additional, Blanc-Lasserre, Karine, additional, Blanco Gonzales, Miguel, additional, Bobinger, Tobias, additional, Bodechtel, Ulf, additional, Bodiguel, Eric, additional, Bojaryn, Urszula, additional, Bonnet, Louise, additional, Bouamra, Benjamin, additional, Bourgeois, Paul, additional, Breuer, Lorenz, additional, Breynaert, Ludovic, additional, Broughton, David, additional, Brouns, Raf, additional, Brugirard, Sébastian, additional, Bruneel, Bart, additional, Buggle, Florian, additional, Cakmak, Serkan, additional, Calleja, Ana, additional, Calvet, David, additional, Carrera, David, additional, Chen, Hsin-Chieh, additional, Cheripelli, Bharath, additional, Cho, Tae-Hee, additional, Choe, Chi-un, additional, Choy, Lillian, additional, Christensen, Hanne, additional, Ciatipis, Mareva, additional, Cloud, Geoffrey, additional, Cogez, Julien, additional, Cortijo, Elisa, additional, Crozier, Sophie, additional, Damgaard, Dorte, additional, Dani, Krishna, additional, De Coene, Beatrijs, additional, De Hollander, Isabel, additional, De Keyser, Jacques, additional, De Klippel, Nina, additional, De Maeseneire, Charlotte, additional, De Smedt, Ann, additional, del Mar Castellanos Rodrigo, Maria, additional, Deltour, Sandrine, additional, Demeestere, Jelle, additional, Derex, Laurent, additional, Desfontaines, Philippe, additional, Dittrich, Ralf, additional, Dixit, Anand, additional, Dobbels, Laurens, additional, Domigo, Valérie, additional, Dorado, Laura, additional, Druart, Charlotte, additional, Dupont, Kristina Hougaard, additional, Dusart, Anne, additional, Dziewas, Rainer, additional, Ebner, Matthias, additional, Edjali-Goujon, Myriam, additional, Eisele, Philipp, additional, El Tawil, Salwa, additional, Elhfnawy, Ahmed, additional, Etexberria, Ana, additional, Evans, Nicholas, additional, Fandler, Simon, additional, Fazekas, Franz, additional, Felix, Sandra, additional, Fiebach, Jochen B., additional, Fiehler, Jens, additional, Filipov, Alexandra, additional, Filipski, Katharina, additional, Fleischmann, Robert, additional, Foerch, Christian, additional, Ford, Ian, additional, Gaenslen, Alexandra, additional, Galinovic, Ivana, additional, Gancedo, Elena Meseguer, additional, Ganeshan, Ramanan, additional, García Esperón, Carlos, additional, Garrido, Alicia, additional, Gattringer, Thomas, additional, Geraghty, Olivia, additional, Geran, Rohat, additional, Gerner, Stefan, additional, Godon-Hardy, Sylvie, additional, Göhler, Jos, additional, Golsari, Amir, additional, Gomis, Meritxell, additional, Gorriz, David, additional, Gramse, Verena, additional, Grau, Laia, additional, Griebe, Martin, additional, Guerrero, Cristina, additional, Guerzoglu, Damla, additional, Guettier, Sophie, additional, Guiraud, Vincent, additional, Gumbinger, Christoph, additional, Gunreben, Ignaz, additional, Haertig, Florian, additional, Hametner, Christian, additional, Hanseeuw, Bernard, additional, Hansen, Andreas, additional, Hansen, Jakob, additional, Harbo, Thomas, additional, Harloff, Andreas, additional, Harmel, Peter, additional, Häusler, Karl Georg, additional, Heinen, Florian, additional, Held, Valentin, additional, Hellwig, Simon, additional, Hemelsoet, Dimitri, additional, Hennerici, Michael, additional, Herm, Juliane, additional, Hermans, Sylvia, additional, Hernández, María, additional, Hervas Vicente, Jose, additional, Hjort, Niels, additional, Hobeanu, Cristina, additional, Hobohm, Carsten, additional, Höfner, Elmar, additional, Hohenbichler, Katharina, additional, Hommel, Marc, additional, Hoppe, Julia, additional, Hornberger, Eva, additional, Hoyer, Carolin, additional, Huang, Xuya, additional, Ipsen, Nils, additional, Isern, Irina, additional, Ispierto, Lourdes, additional, Iversen, Helle, additional, Jeppesen, Lise, additional, Jimenez, Marta, additional, Jungehülsing, Jan, additional, Jüttler, Eric, additional, Kalladka, Dheeraj, additional, Kallmünzer, Bernd, additional, Kar, Arindam, additional, Kellert, Lars, additional, Kemmling, André, additional, Kessler, Tobias, additional, Khan, Usman, additional, Klein, Matthias, additional, Kleinschnitz, Christoph, additional, Klockziem, Matti, additional, Knops, Michael, additional, Koehler, Luzie, additional, Koehrmann, Martin, additional, Kohlfürst, Heinz, additional, Kollmar, Rainer, additional, Kraft, Peter, additional, Krause, Thomas, additional, Kristensen, Bo, additional, Kröber, Jan M., additional, Kurka, Natalia, additional, Ladoux, Alexandre, additional, Laloux, Patrice, additional, Lamy, Catherine, additional, Landrault, Emmanuelle, additional, Lauer, Arne, additional, Lebely, Claire, additional, Leempoel, Jonathan, additional, Lees, Kennedy, additional, Leger, Anne, additional, Legrand, Laurence, additional, Li, Lin, additional, Löbbe, Anna-Mareike, additional, London, Frederic, additional, Lopez-cancio, Elena, additional, Lorenz, Matthias, additional, Louw, Stephen, additional, Lovelock, Caroline, additional, Lozano Sánchez, Manuel, additional, Lucente, Giuseppe, additional, Lückl, Janos, additional, Luna, Alain, additional, Macha, Kosmas, additional, Machet, Alexandre, additional, Mackenrodt, Daniel, additional, Madzar, Dominik, additional, Majoie, Charles, additional, Männer, Anika, additional, Maqueda, Vicky, additional, Marstrand, Jacob, additional, Martinez, Alicia, additional, Marzina, Annika, additional, Mechthouff, Laura, additional, Meden, Per, additional, Meersman, Guy, additional, Meier, Julia, additional, Mellerio, Charles, additional, Menn, Oliver, additional, Meyer, Nadja, additional, Michalski, Dominik, additional, Michels, Peter, additional, Michelsen, Lene, additional, Millán Torne, Monica, additional, Minnerup, Jens, additional, Modrau, Boris, additional, Moeller, Sebastian, additional, Møller, Anette, additional, Morel, Nathalie, additional, Moreton, Fiona, additional, Morin, Ludovic, additional, Moulin, Thierry, additional, Moynihan, Barry, additional, Mueller, Anne K., additional, Muir, Keith W., additional, Mulero, Patricia, additional, Mundiyanapurath, Sibu, additional, Mutzenbach, Johannes, additional, Nagel, Simon, additional, Naggara, Oliver, additional, Nallasivan, Arumugam, additional, Navalpotro, Irene, additional, Nave, Alexander H., additional, Nederkoorn, Paul, additional, Neeb, Lars, additional, Neugebauer, Hermann, additional, Neumann-Haefelin, Tobias, additional, Oberndorfer, Stefan, additional, Opherk, Christian, additional, Oppel, Lorenz, additional, Oppenheim, Catherine, additional, Orthgieß, Johannes, additional, Ostergaard, Leif, additional, Paindeville, Perrine, additional, Palomeras, Ernest, additional, Panitz, Verena, additional, Patel, Bhavni, additional, Peeters, Andre, additional, Peeters, Dirk, additional, Pellisé, Anna, additional, Pelz, Johann, additional, Pereira, Anthony, additional, Pérez de la Ossa, Natalia, additional, Perry, Richard, additional, Petraza, Salvador, additional, Peysson, Stéphane, additional, Pfeilschifter, Waltraud, additional, Pichler, Alexander, additional, Pierskalla, Alexandra, additional, Pledl, Hans-Werner, additional, Poli, Sven, additional, Pomrehn, Katrin, additional, Poulsen, Marika, additional, Prats, Luis, additional, Presas, Silvia, additional, Prohaska, Elisabeth, additional, Puetz, Volker, additional, Puig, Josep, additional, Puig Alcántara, Josep, additional, Purrucker, Jan, additional, Quenardelle, Veronique, additional, Ramachandran, Sankaranarayanan, additional, Raphaelle, Soulliard, additional, Raposo, Nicolas, additional, Reiff, Tilman, additional, Remmers, Michel, additional, Renou, Pauline, additional, Ribitsch, Martin, additional, Richter, Hardy, additional, Ritter, Martin, additional, Ritzenthaler, Thomas, additional, Rodier, Gilles, additional, Rodriguez-Regent, Christine, additional, Rodríguez-Yáñez, Manuel, additional, Roennefarth, Maria, additional, Roffe, Christine, additional, Rosenbaum, Sverre, additional, Rosso, Charlotte, additional, Röther, Joachim, additional, Rozanski, Michal, additional, Ruiz de Morales, Noelia, additional, Russo, Francesca, additional, Rutgers, Matthieu, additional, Sagnier, Sharmilla, additional, Samson, Yves, additional, Sánchez, Josep, additional, Sauer, Tamara, additional, Schäfer, Jan H., additional, Schieber, Simon, additional, Schill, Josef, additional, Schlak, Dennis, additional, Schlemm, Ludwig, additional, Schmidt, Sein, additional, Schonewille, Wouter, additional, Schröder, Julian, additional, Schulz, Andreas, additional, Schurig, Johannes, additional, Schwarting, Sönke, additional, Schwarz, Alexander, additional, Schwarzbach, Christopher, additional, Seidel, Matthias, additional, Seiler, Alexander, additional, Sembill, Jochen, additional, Serena Leal, Joaquin, additional, Shetty, Ashit, additional, Sibon, Igor, additional, Simonsen, Claus Z., additional, Singer, Oliver, additional, Sivagnanaratham, Aravinth, additional, Smets, Ide, additional, Smith, Craig, additional, Soors, Peter, additional, Sprigg, Nikola, additional, Spruegel, Maximilian, additional, Stark, David, additional, Steinert, Susanne, additional, Stösser, Sebastian, additional, Stuermlinger, Markus, additional, Swinnen, Bart, additional, Tamazyan, Ruben, additional, Tembl, Jose, additional, Terceno Izaga, Mikel, additional, Thomalla, Götz, additional, Touze, Emmanuel, additional, Truelsen, Thomas, additional, Turc, Guillaume, additional, Turine, Gaetane, additional, Tütüncü, Serdar, additional, Tyrell, Pippa, additional, Ustrell, Xavier, additional, Vadot, Wilfried, additional, Vallet, Anne-Evelyne, additional, Vallet, Pauline, additional, van den Berg, Lucie, additional, van den Berg, Sophie, additional, van Eendenburg, Cecile, additional, Van Hooff, Robbert-Jan, additional, van Sloten, Isabelle, additional, Vanacker, Peter, additional, Vancaester, Evelien, additional, Vanderdonckt, Patrick, additional, Vandermeeren, Yves, additional, Vanhee, Frederik, additional, Veltkamp, Roland, additional, Vestergaard, Karsten, additional, Viguier, Alain, additional, Vilas, Dolores, additional, Villringer, Kersten, additional, Voget, Dieke, additional, von Schrader, Jörg, additional, von Weitzel, Paul, additional, Warburton, Elisabeth, additional, Weber, Claudia, additional, Weber, Jörg, additional, Wegscheider, Karl, additional, Wegscheider, Mirko, additional, Weimar, Christian, additional, Weinstich, Karin, additional, Weise, Christopher, additional, Weise, Gesa, additional, Willems, Chris, additional, Winder, Klemens, additional, Wittayer, Matthias, additional, Wolf, Marc, additional, Wolf, Martin, additional, Wolff, Valerie, additional, Wollboldt, Christian, additional, Wollenweber, Frank, additional, Wouters, Anke, additional, Yalo, Bertrand, additional, Yger, Marion, additional, Younan, Nadia, additional, Yperzeele, Laetita, additional, Zegarac, Vesna, additional, Zeiner, Pia, additional, Ziemann, Ulf, additional, Zonneveld, Thomas, additional, Zuber, Mathieu, additional, Akutsu, Tsugio, additional, Aoki, Junya, additional, Arakawa, Shuji, additional, Doijiri, Ryosuke, additional, Egashira, Yusuke, additional, Enomoto, Yukiko, additional, Furui, Eisuke, additional, Furuta, Konosuke, additional, Gotoh, Seiji, additional, Hamasaki, Toshimitsu, additional, Hasegawa, Yasuhiro, additional, Hirano, Teryuki, additional, Homma, Kazunari, additional, Ichijyo, Masahiko, additional, Ide, Toshihiro, additional, Igarashi, Shuichi, additional, Iguchi, Yasuyuki, additional, Ihara, Masafumi, additional, Ikenouchi, Hajime, additional, Inoue, Tsuyoshi, additional, Itabashi, Ryo, additional, Ito, Yasuhiro, additional, Iwama, Toru, additional, Kamiyama, Kenji, additional, Kamiyoshi, Shoko, additional, Kanai, Haruka, additional, Kanematsu, Yasuhisa, additional, Kanzawa, Takao, additional, Kimura, Kazumi, additional, Kitayama, Jiro, additional, Kitazono, Takanari, additional, Kondo, Rei, additional, Kudo, Kohsuke, additional, Kusumi, Masayoshi, additional, Kuwahara, Ken, additional, Matsumoto, Shoji, additional, Matsuoka, Hideki, additional, Mihara, Ban, additional, Minematsu, Kazuo, additional, Miura, Ken, additional, Morita, Naomi, additional, Mouri, Wataru, additional, Murata, Kayo, additional, Nagakane, Yoshinari, additional, Nakase, Taizen, additional, Ohara, Hiromi, additional, Ohara, Nobuyuki, additional, Ohnishi, Hideyuki, additional, Ohta, Hajime, additional, Ohtaki, Masafumi, additional, Ohtani, Ryo, additional, Ohtsuki, Toshiho, additional, Ohyama, Hideo, additional, Okada, Takashi, additional, Okada, Yasushi, additional, Osaki, Masato, additional, Sakai, Nobuyuki, additional, Sanbongi, Yoshiki, additional, Sasaki, Naoshi, additional, Sasaki, Makoto, additional, Sato, Shoichiro, additional, Seki, Kenta, additional, Shimizu, Wataru, additional, Shiokawa, Yoshiaki, additional, Sozu, Takashi, additional, Suzuki, Junichiro, additional, Suzuki, Rieko, additional, Takagi, Yasushi, additional, Takizawa, Shunya, additional, Tanahashi, Norio, additional, Tanaka, Eijiro, additional, Tanaka, Ryota, additional, Tateishi, Yohei, additional, Terada, Tomoaki, additional, Terasaki, Tadashi, additional, Todo, Kenichi, additional, Tokunaga, Azusa, additional, Tsujino, Akira, additional, Ueda, Toshihiro, additional, Uesaka, Yoshikazu, additional, Uotani, Mihoko, additional, Urabe, Takao, additional, Watanabe, Masao, additional, Yagita, Yoshiki, additional, Yakushiji, Yusuke, additional, Yasui, Keizo, additional, Yonehara, Toshiro, additional, Yoshimura, Shinichi, additional, Aarnio, K., additional, Alemseged, F., additional, Anderson, C., additional, Ang, T., additional, Archer, M.L., additional, Attia, J., additional, Bailey, P., additional, Balabanski, A., additional, Barber, A., additional, Barber, P.A., additional, Bernhardt, J., additional, Bivard, A., additional, Blacker, D., additional, Bladin, C.F., additional, Brodtmann, A., additional, Cadilhac, D., additional, Campbell, B.C.V., additional, Carey, L., additional, Celestino, S., additional, Chan, L., additional, Chang, W.H., additional, ChangI, A., additional, Chen, C.H., additional, Chen, C.-I., additional, Chen, H.F., additional, Chen, T.C., additional, Chen, W.H., additional, Chen, Y.Y., additional, Cheng, C.A., additional, Cheong, E., additional, Chiou, Y.W., additional, Choi, P.M., additional, Chu, H.J., additional, Chuang, C.S., additional, Chung, T.C., additional, Churilov, L., additional, Clissold, B., additional, Connelly, A., additional, Coote, S., additional, Coulton, B., additional, Cowley, E., additional, Cranefield, J., additional, Curtze, S., additional, D'Este, C., additional, Davis, S.M., additional, Day, S., additional, Desmond, P.M., additional, Dewey, H.M., additional, Ding, C., additional, Donnan, G.A., additional, Drew, R., additional, Eirola, S., additional, Field, D., additional, Frost, T., additional, Garcia-Esperon, C., additional, George, K., additional, Gerraty, R., additional, Grimley, R., additional, Guo, Y.C., additional, Hankey, G., additional, Harvey, J., additional, Ho, S.C., additional, Hogan, K., additional, Howells, D., additional, Hsiao, P.M., additional, Hsu, C.H., additional, Hsu, C.T., additional, Hsu, C.-S., additional, Hsu, J.P., additional, Hsu, Y.D., additional, Hsu, Y.T., additional, Hu, C.J., additional, Huang, C.C., additional, Huang, H.Y., additional, Huang, M.Y., additional, Huang, S.C., additional, Huang, W.S., additional, Jackson, D., additional, Jeng, J.S., additional, Jiang, S.K., additional, Kaauwai, L., additional, Kasari, O., additional, King, J., additional, Kleinig, T.J., additional, Koivu, M., additional, Kolbe, J., additional, Krause, M., additional, Kuan, C.W., additional, Kung, W.L., additional, Kyndt, C., additional, Lau, C.L., additional, Lee, A., additional, Lee, C.Y., additional, Lee, J.T., additional, Lee, Y., additional, Lee, Y.C., additional, Levi, C., additional, Levi, C.R., additional, Lien, L.M., additional, Lim, J.C., additional, Lin, C.C., additional, Lin, C.H., additional, Lin, C.M., additional, Lin, D., additional, Liu, C.H., additional, Liu, J., additional, Lo, Y.C., additional, Loh, P.S., additional, Low, E., additional, Lu, C.H., additional, Lu, C.J., additional, Lu, M.K., additional, Ly, J., additional, Ma, H., additional, Macaulay, L., additional, Macdonnell, R., additional, Mackey, E., additional, Macleod, M., additional, Mahadevan, J., additional, Maxwell, V., additional, McCoy, R., additional, McDonald, A., additional, McModie, S., additional, Meretoja, A., additional, Mishra, S., additional, Mitchell, P.J., additional, Miteff, F., additional, Moore, A., additional, Muller, C., additional, Ng, F., additional, Ng, F.C., additional, Ng, J-L., additional, O'Brian, W., additional, O'Collins, V., additional, Oxley, T.J., additional, Parsons, M.W., additional, Patel, S., additional, Peng, G.S., additional, Pesavento, L., additional, Phan, T., additional, Rodrigues, E., additional, Ross, Z., additional, Sabet, A., additional, Sallaberger, M., additional, Salvaris, P., additional, Shah, D., additional, Sharma, G., additional, Sibolt, G., additional, Simpson, M., additional, Singhal, S., additional, Snow, B., additional, Spratt, N., additional, Stark, R., additional, Sturm, J., additional, Sun, M.C., additional, Sun, Y., additional, Sung, P.S., additional, Sung, Y.F., additional, Suzuki, M., additional, Tan, M., additional, Tang, S.C., additional, Tatlisumak, T., additional, Thijs, V., additional, Tiainen, M., additional, Tsai, C.H., additional, Tsai, C.K., additional, Tsai, C.L., additional, Tsai, H.T., additional, Tsai, L.K., additional, Tseng, C.H., additional, Tseng, L.T., additional, Tsoleridis, J., additional, Tu, H., additional, Tu, H.T-H., additional, Vallat, W., additional, Virta, J., additional, Wang, W.C., additional, Wang, Y.T., additional, Waters, M., additional, Weir, L., additional, Wijeratne, T., additional, Williams, C., additional, Wilson, W., additional, Wong, A.A., additional, Wong, K., additional, Wu, T.Y., additional, Wu, Y.H., additional, Yan, B., additional, Yang, F.C., additional, Yang, Y.W., additional, Yassi, N., additional, Yeh, H.L., additional, Yeh, J.H., additional, Yeh, S.J., additional, Yen, C.H., additional, Young, D., additional, Ysai, C.L., additional, Zhang, W.W., additional, Zhao, H., additional, Zhao, L., additional, Althaus-Knaurer, Katharina, additional, Berrouschot, Jörg, additional, Bluhmki, Erich, additional, Bovi, Paolo, additional, Chatellier, Gilles, additional, Cove, Lynda, additional, Davis, Stephen, additional, Dixit, A., additional, Donnan, Geoffrey, additional, Ehrenkrona, Christina, additional, Eschenfelder, Christoph, additional, Fatar, Marc, additional, Francisco Arenillas, Juan, additional, Gruber, Franz, additional, Kala, Lalit, additional, Kapeller, Peter, additional, Kaste, Markku, additional, Kessler, Christof, additional, Köhrmann, Martin, additional, Laage, Rico, additional, Lees, Kennedy R., additional, Luna Rodriguez, Alain, additional, Mas, Jean-Louis, additional, Mikulik, Robert, additional, Molina, Carlos, additional, Muddegowda, Girish, additional, Muir, Keith, additional, Niederkorn, Kurt, additional, Nuñez, Xavier, additional, Schellinger, Peter, additional, Serena, Joaquin, additional, Sobesky, Jan, additional, Steiner, Thorsten, additional, Svenson, Ann-Sofie, additional, von Kummer, Rüdiger, additional, Wardlaw, Joanna, additional, Betensky, Rebecca A., additional, Boulouis, Gregoire, additional, Carandang, Raphael A., additional, Copen, William A., additional, Cougo, Pedro, additional, Cutting, Shawna, additional, Drake, Kendra, additional, Ford, Andria L., additional, Hallenbeck, John, additional, Harris, Gordon J., additional, Hoesch, Robert, additional, Hsia, Amie, additional, Kase, Carlos, additional, Latour, Lawrence, additional, Lev, Michael H., additional, Muzikansky, Alona, additional, Nagaraja, Nandakumar, additional, Schwamm, Lee H., additional, Searls, Eric, additional, Song, Shlee S., additional, Starkman, Sidney, additional, Yoo, Albert J., additional, and Zand, Ramin, additional

Published
2020
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30. Rationale and Design of a Prospective, Multicenter, Single-Arm Clinical Trial to Investigate the Safety and Effectiveness of Rotablator Atherectomy System as an Adjunctive Device for Endovascular Treatment of Occlusive Atherosclerotic Lesions in Below-the-Knee Arteries With Critical Limb Ischemia (RESCUE-BTK)

Author

Yagyu, Takeshi, primary, Ito, Shin, additional, Kawarada, Osami, additional, Mizuseki, Mitsuyo, additional, Yamamoto, Haruko, additional, Asakura, Masanori, additional, Funabashi, Sayaka, additional, Onda, Kaori, additional, Ohshima, Kikuko, additional, Fukuda-Doi, Mayumi, additional, Asakura, Koko, additional, Kitakaze, Masafumi, additional, Noguchi, Teruo, additional, and Yasuda, Satoshi, additional

Published
2020
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32. Intensive Blood Pressure Lowering With Nicardipine for Better Outcomes After Intracerebral Haemorrhage: A Systematic Review and Meta-Analysis of Individual Participant Data

Author

Toyoda, Kazunori, primary, Yoshimura, Sohei, additional, Fukuda-Doi, Mayumi, additional, Qureshi, Adnan I., additional, Martin, Renee&apos; Hebert, additional, Palesch, Yuko Y., additional, Ihara, Masafumi, additional, Suarez, Jose I., additional, Okada, Yasushi, additional, Hsu, Chung Y., additional, Itabashi, Ryo, additional, Wang, Yongjun, additional, Yamagami, Hiroshi, additional, Steiner, Thorsten, additional, Sakai, Nobuyuki, additional, Yoon, Byung-Woo, additional, Inoue, Manabu, additional, Minematsu, Kazuo, additional, Yamamoto, Haruko, additional, Koga, Masatoshi, additional, Investigators, ATACH Trial, additional, and Investigators, SAMURAI, additional

Published
2020
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33. Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization

Author

Hayakawa, Mikito, primary, Sugiu, Kenji, additional, Yoshimura, Shinichi, additional, Hishikawa, Tomohito, additional, Yamagami, Hiroshi, additional, Fukuda-Doi, Mayumi, additional, Sakai, Nobuyuki, additional, Iihara, Koji, additional, Ogasawara, Kuniaki, additional, Oishi, Hidenori, additional, Ito, Yasushi, additional, and Matsumaru, Yuji, additional

Published
2020
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35. Thrombolysis with Alteplase at 0·6 mg/kg for Acute FLAIR-Negative Stroke with Unknown Time of Onset: THAWS Randomized Controlled Trial

Author

Koga, Masatoshi, primary, Yamamoto, Haruko, additional, Inoue, Manabu, additional, Asakura, Koko, additional, Aoki, Junya, additional, Hamasaki, Toshimitsu, additional, Kanzawa, Takao, additional, Kondo, Rei, additional, Ohtaki, Masafumi, additional, Itabashi, Ryo, additional, Kamiyama, Kenji, additional, Iwama, Toru, additional, Nakase, Taizen, additional, Yakushiji, Yusuke, additional, Igarashi, Shuichi, additional, Nagakane, Yoshinari, additional, Takizawa, Shunya, additional, Okada, Yasushi, additional, Doijiri, Ryosuke, additional, Tsujino, Akira, additional, Ito, Yasuhiro, additional, Ohnishi, Hideyuki, additional, Inoue, Takeshi, additional, Takagi, Yasushi, additional, Hasegawa, Yasuhiro, additional, Shiokawa, Yoshiaki, additional, Sakai, Nobuyuki, additional, Osaki, Masato, additional, Uesaka, Yoshikazu, additional, Yoshimura, Shinichi, additional, Urabe, Takao, additional, Ueda, Toshihiro, additional, Ihara, Masafumi, additional, Kitazono, Takanari, additional, Sasaki, Makoto, additional, Oita, Akira, additional, Yoshimura, Sohei, additional, Fukuda-Doi, Mayumi, additional, Miwa, Kaori, additional, Kimura, Kazumi, additional, Minematsu, Kazuo, additional, Toyoda, Kazunori, additional, and Investigators, THAWS Trial, additional

Published
2019
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36. Clinical Outcomes Depending on Acute Blood Pressure After Cerebral Hemorrhage.

Author

Toyoda, Kazunori, Koga, Masatoshi, Yamamoto, Haruko, Foster, Lydia, Palesch, Yuko Y., Wang, Yongjun, Sakai, Nobuyuki, Hara, Takayuki, Hsu, Chung Y., Itabashi, Ryo, Sato, Shoichiro, Fukuda‐Doi, Mayumi, Steiner, Thorsten, Yoon, Byung‐Woo, Hanley, Daniel F., Qureshi, Adnan I., Fukuda-Doi, Mayumi, Yoon, Byung-Woo, and ATACH-2 Trial Investigators

Subjects
HEALTH outcome assessment, SYSTOLIC blood pressure, SUBARACHNOID hemorrhage, ANTIHYPERTENSIVE agents, STROKE-related mortality, HEMATOMA
Abstract

Objective: To determine the association between clinical outcomes and acute systolic blood pressure (SBP) levels achieved after intracerebral hemorrhage (ICH).Methods: Eligible patients who were randomized to the ATACH-2 (Antihypertensive Treatment in Intracerebral Hemorrhage 2) trial (ClinicalTrials.gov: NCT01176565) were divided into 5 groups by 10-mmHg strata of average hourly minimum SBP (<120, 120-130, 130-140, 140-150, and ≥ 150 mmHg) during 2 to 24 hours after randomization. Outcomes included: 90-day modified Rankin Scale (mRS) 4 to 6; hematoma expansion, defined as an increase ≥6 ml from baseline to 24-hour computed tomography; and cardiorenal adverse events within 7 days.Results: Of the 1,000 subjects in ATACH-2, 995 with available SBP data were included in the analyses. The proportion of mRS 4 to 6 was 37.5, 36.0, 42.8, 38.6, and 38.0%, respectively. For the "140 to 150" group relative to the "120 to 130," the odds ratio (OR), adjusting for sex, race, age, onset-to-randomization time, baseline National Institutes of Health Stroke Scale score, hematoma volume, and hematoma location, was 1.62 (95% confidence interval [CI], 1.02-2.58). Hematoma expansion was identified in 16.9, 13.7, 21.4, 18.5, and 26.4%, respectively. The 140 to 150 (OR, 1.80; 95% CI, 1.05-3.09) and "≥150" (1.98; 1.12-3.51) showed a higher frequency of expansion than the 120 to 130 group. Cardiorenal events occurred in 13.6, 16.6, 11.5, 8.1, and 8.2%, respectively. The 140 to 150 (0.43; 0.19-0.88) and ≥ 150 (0.44; 0.18-0.96) showed a lower frequency of the events than the 120 to 130.Interpretation: Beneficial effects of lowering and maintaining SBP at 120 to 130 mmHg during the first 24 hours on clinical outcomes by suppressing hematoma expansion was somewhat offset by cardiorenal complications. ANN NEUROL 2019;85:105-113. [ABSTRACT FROM AUTHOR]

Published
2019
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38. Abstract WMP10: Sex Difference In Imaging-based Intravenous Thrombolysisfor Ischemic Stroke With Unknown Onset Time: A Pooled Analysis Of Clinical Trials

Author

Fukuda-doi, Mayumi, Koga, Masatoshi, Thomalla, Götz, Jensen, Märit, Inoue, Manabu, Yoshimura, Sohei, Miwa, Kaori, Gerloff, Christian P, Davis, Stephen, Donnan, Geoffrey A, Ma, Henry, Hacke, Werner, Ringleb, Peter, Wu, Ona, Schwamm, Lee H, Warach, Steven J, Boutitie, Florent, and Toyoda, Kazunori

Abstract

Introduction:Our prior meta-analysis reported that imaging-based intravenous thrombolysis (IVT) was safe and effective for patients who have had a stroke with an unknown onset time. The aim of this study is to investigate whether sex differences exist in clinical outcomes among this population.Methods:This is a pooled analysis of individual patient-level data acquired from the EOS project, a meta-analysis of clinical trials (PROSPERO, CRD42020166903). Patients treated with imaging-based IVT for stroke with an unknown time of onset were included. The primary outcome was a favorable functional outcome (mRS 0-1) at 90 days. Secondary outcomes were mRS shift towards a better functional outcome and death within 90 days. Sex differences were investigated using mixed-effect logistic or ordinal regression models adjusted for covariates, considering potential heterogeneity across trials.Results:Among 509 patients treated with imaging-based IVT, 204 (40.1%) were women. Compared to men, women were older (70±12 vs. 67±13, p=0.003), more frequently had atrial fibrillation (27.6% vs. 17.2%, p=0.005), and were taking antiplatelets prior to the onset (45.5% vs. 36.4%, p=0.045). Baseline NIHSS score was higher (8.0 (IQR 5-15) vs.6 (4-11), p<0.001), and hours from last-known-well to treatment were longer (11.2 (9.3-12.9) vs. 10.3 (8.1-11.9), p<0.001) in women than men. Favorable outcomes occurred in 80 (40.6%) women and in 150 (49.7%) men (p=0.047). Among women, 19 (9.6%) patients died, compared with 15 (5.0%) patients in men (p=0.042). After multivariate adjustment, female sex was not significantly associated with favorable functional outcome (adjusted odds ratio (OR) 1.01[95% confidential intervals (CI) 0.66-1.54]; p=0.97) nor death (adjusted OR 1.28 [95%CI 0.59-2.76]; p=0.59). Female sex was not associated with a significant shift towards the better functional outcome (common OR 1.07 [95%CI 0.77-1.49]; p=0.70).Conclusions:Pooled data from clinical trials show that in univariate analysis, women had numerically less good functional outcomes following imaging-based IVT among ischemic stroke patients with unknown onset time. However, this sex difference can be explained by higher age and more severe clinical status in women at stroke onset.

Published
2022
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39. Abstract 10997: Impact of Atrial Fibrillation on 1-year Mortality in Transcatheter Repair of Severe Functional Mitral Regurgitation

Author

Harada, Rakushumimarika, Hieda, Michinari, Mantha, Yogamaya, Fukuda-Doi, Mayumi, Cheirif, Jorge, and Feldman, Mark

Abstract

Background:Percutaneous mitral valve repair with MitraClip has become a widespread therapeutic option for high-risk patients with severe mitral regurgitation. Nevertheless, limited evidence is available for MitraClip in patients with severe mitral regurgitation who have atrial fibrillation (AF). The aim of this study was to reveal any association between AF and long-term survival in patients with severe mitral regurgitation undergoing MitraClip implantation.Hypothesis:We hypothesized that severe mitral regurgitation with AF may have a negative impact on 1-year mortality compared to severe mitral regurgitation without AF.Methods:A total of 2,337 patients were analyzed from six retrospective and seven prospective cohort studies; all had severe mitral regurgitation undergoing MitraClip placement. Of these 2,337 patients, 980 (42%) had known AF prior to receiving the clips. Our study focused on the association between the preexisting AF rate and the 1 year all cause mortality rate after MitraClip placement. The data and 1-year clinical outcomes were analyzed by meta-regression linear prediction with JMP Ver. 11 and Revman 5.0.Results:The average overall 1-year mortality among the 13 studies was 19.9?7.0%. A positive correlation was identified between preexisting AF rate per study and 1-year all cause mortality rate (R=0.56, P=0.034) (Figure). The estimated 1-year mortality rate associated with AF in patients with MitraClip placement was extrapolated: estimated 1-year mortality rate (%) = 0.25? AF rate (%) + 6.7.Conclusions:There is a significant correlation between preexisting AF and 1-year survival rate in patients who received MitraClip treatment. Further studies are recommended to investigate if AF is an independent risk factor to increase the mortality among patients who undergo MitraClip placement.

Published
2019
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40. Magnetic Resonance Imaging-Guided Intravenous Thrombolysis in Cardioembolic Stroke Patients With Unknown Time of Onset　- Subanalysis of the THAWS Randomized Control Trial.

Author

Yamazaki N, Koga M, Doijiri R, Inoue M, Miwa K, Yoshimura S, Fukuda-Doi M, Aoki J, Asakura K, Sasaki M, Kitazono T, Kimura K, Minematsu K, Yamamoto H, Ihara M, and Toyoda K

Subjects
Humans, Fibrinolytic Agents adverse effects, Magnetic Resonance Imaging methods, Thrombolytic Therapy adverse effects, Thrombolytic Therapy methods, Tissue Plasminogen Activator adverse effects, Treatment Outcome, Brain Ischemia drug therapy, Embolic Stroke, Stroke diagnostic imaging, Stroke drug therapy, Stroke etiology
Abstract

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., 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., Conclusions: When an MRI-guided approach is used, CE patients with unknown time of onset appear to be suitable candidates for thrombolysis.

Published
2024
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41. Regional Differences in the Response to Acute Blood Pressure Lowering After Cerebral Hemorrhage.

Author

Toyoda K, Palesch YY, Koga M, Foster L, Yamamoto H, Yoshimura S, Ihara M, Fukuda-Doi M, Okazaki S, Tanaka K, Miwa K, Hasegawa Y, Shiokawa Y, Iwama T, Kamiyama K, Hoshino H, Steiner T, Yoon BW, Wang Y, Hsu CY, and Qureshi AI

Subjects
Black or African American, Aged, Asian People, Cerebral Hemorrhage diagnostic imaging, Cerebral Hemorrhage physiopathology, China, Disease Progression, Female, Germany, Hematoma diagnostic imaging, Humans, Japan, Male, Middle Aged, Patient Care Planning, Republic of Korea, Taiwan, Tomography, X-Ray Computed, Treatment Outcome, United States, White People, Antihypertensive Agents therapeutic use, Cerebral Hemorrhage drug therapy, Nicardipine therapeutic use
Abstract

Objective: To compare the impact of intensive blood pressure (BP) lowering right after intracerebral hemorrhage (ICH) on clinical and hematoma outcomes among patients from different geographic locations, we performed a prespecified subanalysis of a randomized, multinational, 2-group, open-label trial to determine the efficacy of rapidly lowering BP in hyperacute ICH (Antihypertensive Treatment of Acute Cerebral Hemorrhage [ATACH]-2), involving 537 patients from East Asia and 463 recruited outside of Asia., Methods: Eligible patients were randomly assigned to a systolic BP target of 110 to 139 mm Hg (intensive treatment) or 140 to 179 mm Hg (standard treatment). Predefined outcomes were poor functional outcome (modified Rankin Scale score 4-6 at 90 days), death within 90 days, hematoma expansion at 24 hours, and cardiorenal adverse events within 7 days., Results: Poor functional outcomes (32.0% vs 45.9%), death (1.9% vs 13.3%), and cardiorenal adverse events (3.9% vs 11.2%) occurred significantly less frequently in patients from Asia than those outside of Asia. The treatment-by-cohort interaction was not significant for any outcomes. Only patients from Asia showed a lower incidence of hematoma expansion with intensive treatment (adjusted relative risk [RR] 0.56, 95% confidence interval [CI] 0.38-0.83). Both Asian (RR 3.53, 95% CI 1.28-9.64) and non-Asian (RR 1.71, 95% CI 1.00-2.93) cohorts showed a higher incidence of cardiorenal adverse events with intensive treatment., Conclusions: Poor functional outcomes and death 90 days after ICH were less common in patients from East Asia than those outside of Asia. Hematoma expansion, a potential predictor for poor clinical outcome, was attenuated by intensive BP lowering only in the Asian cohort., Clinicaltrialsgov Identifier: NCT01176565., Classification of Evidence: This study provides Class II evidence that, for patients from East Asia with ICH, intensive blood pressure lowering significantly reduces the risk of hematoma expansion., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Published
2021
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42. Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization.

Author

Hayakawa M, Sugiu K, Yoshimura S, Hishikawa T, Yamagami H, Fukuda-Doi M, Sakai N, Iihara K, Ogasawara K, Oishi H, Ito Y, and Matsumaru Y

Abstract

Objective: Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid artery stenting (CAS). Staged angioplasty (SAP)-i.e., angioplasty followed by delayed CAS-has been reported as a potential CHS-avoiding procedure. The purpose of this study was to clarify the effectiveness of SAP in avoiding CHS after carotid revascularization for patients at high risk for this complication., Methods: The authors retrospectively studied cases involving patients at high risk for CHS from 44 Japanese centers who were scheduled for SAP, regular CAS, angioplasty, or staged procedures other than SAP between October 2007 and March 2014. They investigated the rate of CHS in the population scheduled for SAP or regular CAS, and for safety analysis, the composite rate of transient ischemic attack (TIA) and ischemic stroke in the population eventually receiving SAP or regular CAS., Results: Data from a total of 525 patients (532 lesions, mean age 72.5 ± 7.5 years, 74 women ) were analyzed. Scheduled procedures included SAP for 113 lesions and regular CAS for 419 lesions. The rate of CHS was lower in the SAP group than in the regular CAS group (4.4% vs 10.5%, p = 0.047). Multivariate analysis showed that SAP was negatively related to CHS (OR 0.315; 95% CI 0.120-0.828). In the population eventually receiving SAP (102 lesions) or regular CAS (428 lesions), the composite rate of TIA and ischemic stroke was comparable between the SAP group and the regular CAS group (9.8% vs 9.3%)., Conclusions: SAP may be an effective and safe carotid revascularization procedure to avoid CHS.

Published
2019
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