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4. Distribution of cerebral microbleeds in the East and West: Individual participant meta-analysis.

Author

Yakushiji, Yusuke, Wilson, Duncan, Ambler, Gareth, Charidimou, Andreas, Beiser, Alexa, van Buchem, Mark A, DeCarli, Charles, Ding, Ding, Gudnason, Villi, Hara, Hideo, Imaizumi, Toshio, Kohara, Katsuhiko, Kwon, Hyung-Min, Launer, Lenore J, Mok, Vincent, Phan, Thanh, Preis, Sarah R, Romero, José Rafael, Seshadri, Sudha, Srikanth, Velandai, Takashima, Yuki, Tsushima, Yoshito, Wang, Zhaolu, Wolf, Philip A, Xiong, Yunyun, Yamaguchi, Shuhei, and Werring, David J

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Clinical Research, Stroke, Brain Disorders, Aged, Cerebral Hemorrhage, Female, Humans, Male, Middle Aged, Cognitive Sciences, Neurology & Neurosurgery, Clinical sciences
Abstract

ObjectiveWe investigated differences in the anatomical distribution of cerebral microbleeds (CMBs) on MRI, hypothesized to indicate the type of underlying cerebral small vessel disease (SVD), between Eastern and Western general populations.MethodsWe analyzed data from 11 studies identified by a PubMed search between 1996 and April 2014 according to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data. Study quality measures indicated low or medium risk of bias. We included stroke-free participants from populations aged between 55 and 75 years, categorized by geographic location (Eastern or Western). We categorized CMB distribution (strictly lobar, deep and/or infratentorial [D/I], or mixed [i.e., CMBs located in both lobar and D/I regions]). We tested the hypothesis that Eastern and Western populations have different anatomical distributions of CMBs using multivariable mixed effects logistic regression analyses adjusted for age, sex, and hypertension and clustering by institution.ResultsAmong 8,595 stroke-free individuals (mean age [SD] 66.7 [5.6] years; 48% male; 42% from a Western population), 624 (7.3%) had CMBs (strictly lobar in 3.1%; D/I or mixed in 4.2%). In multivariable mixed effects models, Eastern populations had higher odds of D/I or mixed CMBs (adjusted odds ratio 2.78, 95% confidence interval [CI] 1.77-4.35) compared to Western populations. Eastern populations had a higher number of D/I or mixed CMBs (adjusted prevalence ratio 2.83, 95% CI 1.27-6.31).ConclusionsEastern and Western general populations have different anatomical distributions of CMBs, suggesting differences in the spectrum of predominant underlying SVDs, with potential implications for SVD diagnosis and treatment.

Published
2019

7. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, Gratz, Pascal, Mattle, Heinrich, Panos, Leonidas, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shaloo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Van Dam-Nolen, Dianne, Kooi, M Eline, Van der Lugt, Aad, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Best, Jonathan G, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sanchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Polymeris, Alexandros, Wagner, Benjamin, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, L Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Fischer, Urs, El-Koussy, Marwan, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Mess, Werner H, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Anne Cristine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Kelly, Peter J, Wardlaw, Joanna, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J

Published
2021
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9. Clinical Associations and Prognostic Value of MRI-Visible Perivascular Spaces in Patients With Ischemic Stroke or TIA:A Pooled Analysis

Author

Best, Jonathan G., Ambler, Gareth, Wilson, Duncan, Du, Houwei, Lee, Keon Joo, Lim, Jae Sung, Teo, Kay Cheong, Mak, Henry, Kim, Young Dae, Song, Tae Jin, Selcuk Demirelli, Derya, Nishihara, Masashi, Yoshikawa, Masaaki, Kubacka, Marta, Zietz, Annaelle, Al-Shahi Salman, Rustam, Jäger, Hans Rolf, Lip, Gregory Y.H., Panos, Leonidas, Goeldlin, Martina B., Slater, Lee Anne, Karayiannis, Christopher Charles, Phan, Thanh G., Bellut, Maximilian, Abrigo, Jill, Cheng, Cyrus, Leung, Thomas W., Chu, Winnie, Chappell, Francesca, Makin, Stephen D.J., Van Dam-Nolen, Dianne H.K., Kooi, M. Eline, Köhler, Sebastian, Staals, Julie, Kuchcinski, Grégory, Bordet, Régis, Dubost, Florian, Wardlaw, Joanna M., Soo, Yannie O.Y., Fluri, Felix, Srikanth, Velandai K., Jung, Simon, Peters, Nils, Hara, Hideo, Yakushiji, Yusuke, Necioglu Orken, Dilek, Heo, Ji Hoe, Lau, Gary Kui Kai, Bae, Hee Joon, Werring, David J., Best, Jonathan G., Ambler, Gareth, Wilson, Duncan, Du, Houwei, Lee, Keon Joo, Lim, Jae Sung, Teo, Kay Cheong, Mak, Henry, Kim, Young Dae, Song, Tae Jin, Selcuk Demirelli, Derya, Nishihara, Masashi, Yoshikawa, Masaaki, Kubacka, Marta, Zietz, Annaelle, Al-Shahi Salman, Rustam, Jäger, Hans Rolf, Lip, Gregory Y.H., Panos, Leonidas, Goeldlin, Martina B., Slater, Lee Anne, Karayiannis, Christopher Charles, Phan, Thanh G., Bellut, Maximilian, Abrigo, Jill, Cheng, Cyrus, Leung, Thomas W., Chu, Winnie, Chappell, Francesca, Makin, Stephen D.J., Van Dam-Nolen, Dianne H.K., Kooi, M. Eline, Köhler, Sebastian, Staals, Julie, Kuchcinski, Grégory, Bordet, Régis, Dubost, Florian, Wardlaw, Joanna M., Soo, Yannie O.Y., Fluri, Felix, Srikanth, Velandai K., Jung, Simon, Peters, Nils, Hara, Hideo, Yakushiji, Yusuke, Necioglu Orken, Dilek, Heo, Ji Hoe, Lau, Gary Kui Kai, Bae, Hee Joon, and Werring, David J.

Abstract

Background and Objectives: Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis. Methods: We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression. Results: We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; p = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome. Discussion: In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.

Published
2024

10. Iatrogenic cerebral amyloid angiopathy in older adults.

Author

Panteleienko, Larysa, Mallon, Dermot, Oliver, Rupert, Toosy, Ahmed, Hoshino, Yuki, Murakami, Aya, Kaushik, Kanishk, Wermer, Marieke J. H., Hara, Hideo, Yakushiji, Yusuke, Banerjee, Gargi, and Werring, David J.

Subjects
CEREBRAL amyloid angiopathy, OLDER people, DURA mater, IATROGENIC diseases, NEUROSURGERY, SPINAL cord
Abstract

Background and purpose: An increasing number of cases of iatrogenic cerebral amyloid angiopathy (CAA) have now been reported worldwide. Proposed diagnostic criteria require a history of medical intervention with potential for amyloid‐β transmission, for example those using cadaveric dura mater or requiring instrumentation of the brain or spinal cord. Clinical presentation occurs after an appropriate latency (usually three or four decades); to date, most patients with iatrogenic CAA have had 'early‐onset' disease (compared to sporadic, age‐related, CAA), as a consequence of childhood procedures. Results: We describe five cases of possible iatrogenic CAA in adults presenting in later life (aged 65 years and older); all had prior neurosurgical interventions and presented after a latency suggestive of iatrogenic disease (range 30–39 years). Use of cadaveric dura mater was confirmed in one case, and highly likely in the remainder. Conclusion: The presentation of iatrogenic CAA in older adults widens the known potential spectrum of this disease and highlights the difficulties of making the diagnosis in this age group, and particularly in differentiating iatrogenic from sporadic CAA. Increased vigilance for cases presenting at an older age is essential for furthering our understanding of the clinical phenotype and broader implications of iatrogenic CAA. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Clinical Associations and Prognostic Value of MRI-Visible Perivascular Spaces in Patients With Ischemic Stroke or TIA

Author

Best, Jonathan G., primary, Ambler, Gareth, additional, Wilson, Duncan, additional, Du, Houwei, additional, Lee, Keon-Joo, additional, Lim, Jae-Sung, additional, Teo, Kay Cheong, additional, Mak, Henry, additional, Kim, Young Dae, additional, Song, Tae-Jin, additional, Selcuk Demirelli, Derya, additional, Nishihara, Masashi, additional, Yoshikawa, Masaaki, additional, Kubacka, Marta, additional, Zietz, Annaelle, additional, Al-Shahi Salman, Rustam, additional, Jäger, Hans Rolf, additional, Lip, Gregory Y.H., additional, Panos, Leonidas, additional, Goeldlin, Martina B., additional, Slater, Lee-Anne, additional, Karayiannis, Christopher Charles, additional, Phan, Thanh G., additional, Bellut, Maximilian, additional, Abrigo, Jill, additional, Cheng, Cyrus, additional, Leung, Thomas W., additional, Chu, Winnie, additional, Chappell, Francesca, additional, Makin, Stephen D.J., additional, van Dam-Nolen, Dianne H.K., additional, Kooi, M. Eline, additional, Köhler, Sebastian, additional, Staals, Julie, additional, Kuchcinski, Grégory, additional, Bordet, Régis, additional, Dubost, Florian, additional, Wardlaw, Joanna M., additional, Soo, Yannie O.Y., additional, Fluri, Felix, additional, Srikanth, Velandai K., additional, Jung, Simon, additional, Peters, Nils, additional, Hara, Hideo, additional, Yakushiji, Yusuke, additional, Necioglu Orken, Dilek, additional, Heo, Ji-Hoe, additional, Lau, Gary Kui Kai, additional, Bae, Hee-Joon, additional, and Werring, David J., additional

Published
2024
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14. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, El-Koussy, Marwan, Gratz, Pascal, Molad, Jeremy, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shahoo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos;, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Nishihara, Masashi, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Hendrikse, Jeroen, Nederkoorn, Paul, Mess, Werner, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Wilson, Duncan, Ambler, Gareth, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sánchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Schrooten, Maarten, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Tanaka, Jun, Hara, Hideo, Coutts, Shelagh B, Hert, Lisa, Polymeris, Alexandros, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Mattle, Heinrich P, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Kooi, M Eline, van Dam-Nolen, Dianne H K, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Christine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, van der Lugt, Aad, Kelly, Peter J, Wardlaw, Joanna M, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J

Published
2019
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15. Cerebral Small Vessel Disease Burden for Bleeding Risk during Antithrombotic Therapy: Bleeding with Antithrombotic Therapy 2 Study.

Author

Tanaka, Kanta, Miwa, Kaori, Koga, Masatoshi, Yoshimura, Sohei, Kamiyama, Kenji, Yagita, Yoshiki, Nagakane, Yoshinari, Hoshino, Haruhiko, Terasaki, Tadashi, Okada, Yasushi, Yakushiji, Yusuke, Takahashi, Shinichi, Ueda, Toshihiro, Hasegawa, Yasuhiro, Shiozawa, Masayuki, Sasaki, Makoto, Kudo, Kohsuke, Tanaka, Jun, Nishihara, Masashi, and Yamaguchi, Yoshitaka

Subjects
CEREBRAL small vessel diseases, FIBRINOLYTIC agents, INTRACRANIAL hemorrhage, GASTROINTESTINAL hemorrhage, CEREBROVASCULAR disease
Abstract

Objective: This study was undertaken to determine the excess risk of antithrombotic‐related bleeding due to cerebral small vessel disease (SVD) burden. Methods: In this observational, prospective cohort study, patients with cerebrovascular or cardiovascular diseases taking oral antithrombotic agents were enrolled from 52 hospitals across Japan between 2016 and 2019. Baseline multimodal magnetic resonance imaging acquired under prespecified conditions was assessed by a central diagnostic radiology committee to calculate total SVD score. The primary outcome was major bleeding. Secondary outcomes included bleeding at each site and ischemic events. Results: Of the analyzed 5,250 patients (1,736 women; median age = 73 years, 9,933 patient‐years of follow‐up), antiplatelets and anticoagulants were administered at baseline in 3,948 and 1,565, respectively. Median SVD score was 2 (interquartile range = 1–3). Incidence rate of major bleeding was 0.39 (per 100 patinet‐years) in score 0, 0.56 in score 1, 0.91 in score 2, 1.35 in score 3, and 2.24 in score 4 (adjusted hazard ratio [aHR] for score 4 vs 0 = 5.47, 95% confidence interval [CI] = 2.26–13.23), that of intracranial hemorrhage was 0.11, 0.33, 0.58, 0.99, and 1.06, respectively (aHR = 9.29, 95% CI = 1.99–43.35), and that of ischemic event was 1.82, 2.27, 3.04, 3.91, and 4.07, respectively (aHR = 1.76, 95% CI = 1.08–2.86). In addition, extracranial major bleeding (aHR = 3.43, 95% CI = 1.13–10.38) and gastrointestinal bleeding (aHR = 2.54, 95% CI = 1.02–6.35) significantly increased in SVD score 4 compared to score 0. Interpretation: Total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting the broader clinical relevance of cerebral SVD as a marker for safe implementation of antithrombotic therapy. ANN NEUROL 2024;95:774–787 [ABSTRACT FROM AUTHOR]

Published
2024
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17. 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, G. tz, 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, Kim, Joon-Tae, HUS Neurocenter, Neurologian yksikkö, Department of Neurosciences, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
Rivaroxaban, Plasma-levels, Idarucizumab, 3112 Neurosciences, Intracranial hemorrhage, Recanalization therapies, Endovascular treatment, Neurology (clinical), Reperfusion therapy, 3124 Neurology and psychiatry, Tissue-plasminogen activator, Dabigatran, Management
Abstract

ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis 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.ExposuresPrior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation.Main Outcomes and MeasuresThe 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.ResultsOf 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 RelevanceIn 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

18. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis

Author

Martí-Fàbregas, Joan, Camps-Renom, Pol, Best, Jonathan G, Ramos-Pachon, Anna, Guasch-Jiménez, Marina, Martinez-Domeño, Alejandro, Guisado-Alonso, Daniel, Gómez-Ansón, Beatriz M, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Bae, Hee-Joon, Shiozawa, Masayuki, Koga, Masatoshi, Toyoda, Kazunori, Hennerici, Michael G, Chabriat, Hugues, Jouvent, Eric, Kwun Wong, Debbie Yuen, Mak, Henry, Lau, Kui Kai, Kim, Young Dae, Song, Tae-Jin, Heo, Ji-Hoe, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy A, Nishihara, Masashi, Tanaka, Jun, Hara, Hideo, Yakushiji, Yusuke, Coutts, Shelagh B, Smith, Eric, Polymeris, Alexandros A, Wagner, Benjamin, Seiffge, David, Lyrer, Philippe A, Peters, Nils, Engelter, Stefan T, Al-Shahi Salman, Rustam, Jäger, Hans Rudolf, Lip, Gregory Y H, Goeldlin, Martina, Panos, Leonidas, Karayiannis, Christopher Charles, Phan, Thanh G, Srikanth, Velandai K, Christ, Nicolas, Gunkel, Sarah, Fluri, Felix, Leung, Thomas W, Soo, Yannie O Y, Chu, Winnie, Abrigo, Jill, Barbato, Carmen, Browning, Simone, Simister, Robert, Mendyk, Anne-Marie, Bordet, Régis, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Jung, Simon, Orken, Dilek Necioglu, Werring, David, and Prats-Sanchez, Luis

Subjects
HEMORRHAGE, Neurology (clinical), 610 Medizin und Gesundheit, CEREBRAL AMYLOID ANGIOPATHY, PREVALENCE, Research Article
Abstract

Background and ObjectivesIn patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA.MethodsWe retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.ResultsOf 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14–2.28;p= 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90–60.63;p= 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03–12.44;p< 0.001) compared with the non-cSS group.DiscussionPatients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.

Published
2022

20. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation

Author

Fischer, Urs, primary, Koga, Masatoshi, additional, Strbian, Daniel, additional, Branca, Mattia, additional, Abend, Stefanie, additional, Trelle, Sven, additional, Paciaroni, Maurizio, additional, Thomalla, Götz, additional, Michel, Patrik, additional, Nedeltchev, Krassen, additional, Bonati, Leo H., additional, Ntaios, George, additional, Gattringer, Thomas, additional, Sandset, Else-Charlotte, additional, Kelly, Peter, additional, Lemmens, Robin, additional, Sylaja, P.N., additional, Aguiar de Sousa, Diana, additional, Bornstein, Natan M., additional, Gdovinova, Zuzana, additional, Yoshimoto, Takeshi, additional, Tiainen, Marjaana, additional, Thomas, Helen, additional, Krishnan, Manju, additional, Shim, Gek C., additional, Gumbinger, Christoph, additional, Vehoff, Jochen, additional, Zhang, Liqun, additional, Matsuzono, Kosuke, additional, Kristoffersen, Espen, additional, Desfontaines, Philippe, additional, Vanacker, Peter, additional, Alonso, Angelika, additional, Yakushiji, Yusuke, additional, Kulyk, Caterina, additional, Hemelsoet, Dimitri, additional, Poli, Sven, additional, Paiva Nunes, Ana, additional, Caracciolo, Nicoletta, additional, Slade, Peter, additional, Demeestere, Jelle, additional, Salerno, Alexander, additional, Kneihsl, Markus, additional, Kahles, Timo, additional, Giudici, Daria, additional, Tanaka, Kanta, additional, Räty, Silja, additional, Hidalgo, Rea, additional, Werring, David J., additional, Göldlin, Martina, additional, Arnold, Marcel, additional, Ferrari, Cecilia, additional, Beyeler, Seraina, additional, Fung, Christian, additional, Weder, Bruno J., additional, Tatlisumak, Turgut, additional, Fenzl, Sabine, additional, Rezny-Kasprzak, Beata, additional, Hakim, Arsany, additional, Salanti, Georgia, additional, Bassetti, Claudio, additional, Gralla, Jan, additional, Seiffge, David J., additional, Horvath, Thomas, additional, and Dawson, Jesse, additional

Published
2023
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21. 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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22. Harboring Cnm‐expressing Streptococcus mutans in the oral cavity relates to both deep and lobar cerebral microbleeds.

Author

Ikeda, Shuhei, Saito, Satoshi, Hosoki, Satoshi, Tonomura, Shuichi, Yamamoto, Yumi, Ikenouchi, Hajime, Ishiyama, Hiroyuki, Tanaka, Tomotaka, Hattori, Yorito, Friedland, Robert P., Carare, Roxana O., Kuriyama, Nagato, Yakushiji, Yusuke, Hara, Hideo, Koga, Masatoshi, Toyoda, Kazunori, Nomura, Ryota, Takegami, Misa, Nakano, Kazuhiko, and Ihara, Masafumi

Subjects
STREPTOCOCCUS mutans, CEREBRAL amyloid angiopathy, STROKE, STROKE patients, POLYMERASE chain reaction
Abstract

Background: Cerebral microbleeds (CMBs) influence long‐term prognoses of stroke patients. Streptococcus mutans expressing the collagen‐binding protein Cnm induces cerebrovascular inflammation, impairing blood brain barrier integrity and causing cerebral bleeding. Here, we examine the association of Cnm‐positive S. mutans with CMBs. Methods: Acute stroke patients were selected from a single‐center registry database. Oral carriage of Cnm‐positive or Cnm‐negative S. mutans was determined using polymerase chain reaction assays. The associations of Cnm‐positive S. mutans with CMB number and specifically the presence of >10 CMBs were examined using quasi‐Poisson and logistic regression models, respectively. Results: This study included 3154 stroke patients, of which 428 patients (median [interquartile range] age, 73.0 [63.0–81.0] years; 269 men [62.9%]) underwent oral bacterial examinations. In total, 326 patients harbored S. mutans. After excluding four patients without imaging data, we compared patients with Cnm‐positive (n = 72) and Cnm‐negative (n = 250) S. mutans. Harboring Cnm‐positive S. mutans was independently associated with the presence of >10 CMBs (adjusted odds ratio 2.20 [1.18–4.10]) and higher numbers of deep and lobar CMBs (adjusted risk ratio 1.61 [1.14–2.27] for deep; 5.14 [2.78–9.51] for lobar), but not infratentorial CMBs, after adjusting for age, sex, hypertension, stroke type, National Institutes of Health Stroke Scale score, and cerebral amyloid angiopathy. Conclusions: Harboring Cnm‐positive S. mutans was independently associated with a higher number of CMBs in deep and lobar locations. Reducing Cnm‐positive S. mutans in the oral cavity may serve as a novel therapeutic approach for stroke. [ABSTRACT FROM AUTHOR]

Published
2023
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23. Development of an application for management of drug holidays in perioperative periods

Author

Kimura, Sakiko, Emoto, Akiko, Yoshimura, Mariko, Arimizu, Kota, Kamura, Tomoko, Sogawa, Rintaro, Mizuta, Kikumi, Tagomori, Yasuhiro, Natsuaki, Masahiro, Kajiwara, Masataka, Tsuruoka, Nanae, Yakushiji, Yusuke, Tanigawa, Yoshinori, Takamatsu, Chihiro, Danjo, Atsushi, Kamohara, Keiji, Hirakawa, Naomi, Sakaguchi, Yoshiro, Noguchi, Mitsuru, Noshiro, Hirokazu, Kawaguchi, Atsushi, Sueoka, Eisaburo, Narisawa, Yutaka, and Kimura, Shinya

Published
2020
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24. 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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25. Hypertension, cerebral Amyloid, aGe Associated Known neuroimaging markers of cerebral small vessel disease Undertaken with stroke REgistry (HAGAKURE) prospective cohort study: Baseline characteristics and association of cerebral small vessel disease with prognosis in an ischemic stroke cohort

Author

Ikeda, Shuhei, primary, Yakushiji, Yusuke, additional, Tanaka, Jun, additional, Nishihara, Masashi, additional, Ogata, Atsushi, additional, Eriguchi, Makoto, additional, Ono, Shohei, additional, Kosugi, Masafumi, additional, Suzuyama, Kohei, additional, Mizoguchi, Megumi, additional, Shichijo, Chika, additional, Ide, Toshihiro, additional, Nagaishi, Yukiko, additional, Mori, Hodo, additional, Ono, Natsuki, additional, Yoshikawa, Masaaki, additional, Ide, Kiku, additional, Minagawa, Hiromu, additional, Iida, Kotaro, additional, Kawamoto, Kazuhiro, additional, Katsuki, Yoshiko, additional, Irie, Hiroyuki, additional, Abe, Tatsuya, additional, and Hara, Hideo, additional

Published
2023
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27. Abstract 3: Cerebral Small Vessel Disease Burden For Bleeding Risk During Antithrombotic Therapy -BAT2-

Author

Tanaka, Kanta, primary, Miwa, Kaori, additional, Yoshimura, Sohei, additional, Kamiyama, Kenji, additional, Yagita, Yoshiki, additional, Nagakane, Yoshinari, additional, Hoshino, Haruhiko, additional, Terasaki, Tadashi, additional, Okada, Yasushi, additional, Yakushiji, Yusuke, additional, Takahashi, Shinichi, additional, Ueda, Toshihiro, additional, Hasegawa, Yasuhiro, additional, Shiozawa, Masayuki, additional, Sasaki, Makoto, additional, Kudo, Kohsuke, additional, Tanaka, Jun, additional, Nishihara, Masashi, additional, Yamaguchi, Yoshitaka, additional, Fujita, Kyohei, additional, Honda, Yuko, additional, Kawano, Hiroyuki, additional, Ide, Toshihiro, additional, Yoshimoto, Takeshi, additional, Ihara, Masafumi, additional, Koga, Masatoshi, additional, Hirano, Teruyuki, additional, and Toyoda, Kazunori, additional

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

Author

Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Wilson, Duncan, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Scheitz, Jan F; https://orcid.org/0000-0001-5835-4627, Ringleb, Peter, Goganau, Ioana, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Bae, Hee-Joon, Kim, Do Yeon, Kermer, Pawel, Suzuki, Kentaro, Kimura, Kazumi, Macha, Kosmas, Koga, Masatoshi, Wada, Shinichi, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Salerno, Alexander; https://orcid.org/0000-0001-8494-5527, Palanikumar, Logesh, Zini, Andrea; https://orcid.org/0000-0003-1486-4507, Forlivesi, Stefano, Kellert, Lars, Wischmann, Johannes, Kristoffersen, Espen S; https://orcid.org/0000-0002-8999-5424, Beharry, James, Barber, P Alan, Hong, Jae Beom, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Schlemm, Eckhard, Yakushiji, Yusuke, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, et al, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Wilson, Duncan, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Scheitz, Jan F; https://orcid.org/0000-0001-5835-4627, Ringleb, Peter, Goganau, Ioana, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Bae, Hee-Joon, Kim, Do Yeon, Kermer, Pawel, Suzuki, Kentaro, Kimura, Kazumi, Macha, Kosmas, Koga, Masatoshi, Wada, Shinichi, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Salerno, Alexander; https://orcid.org/0000-0001-8494-5527, Palanikumar, Logesh, Zini, Andrea; https://orcid.org/0000-0003-1486-4507, Forlivesi, Stefano, Kellert, Lars, Wischmann, Johannes, Kristoffersen, Espen S; https://orcid.org/0000-0002-8999-5424, Beharry, James, Barber, P Alan, Hong, Jae Beom, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Schlemm, Eckhard, Yakushiji, Yusuke, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, and et al

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).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis 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.ExposuresPrior 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.ResultsOf 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 sIC

Published
2023

31. 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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33. 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, Shinishi, Altersberger, Valerian, Salerno, Alexander, Palanikumar, Logesh, Zini, Andrea, Forlivesi, Stefano, Kellert, Lars, Wischmann, Johannes, Kristoffersen, Espen, 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., and Seiffge, David J

Subjects
610 Medicine & health
Published
2023
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34. Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

Author

Soo, Yannie, Zietz, Annaelle, Yiu, Brian, Mok, Vincent C T, Polymeris, Alexandros A, Seiffge, David, Ambler, Gareth, Wilson, Duncan, Leung, Thomas Wai Hong, Tsang, Suk Fung, Chu, Winnie, Abrigo, Jill, Cheng, Cyrus, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry, Collet, Roger, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Y K, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Kappelle, L Jaap, Salman, Rustam Al-Shahi, Jager, Rolf, Lip, Gregory Y. H., Goeldlin, Martina B, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Chris, Phan, Thanh, Bellut, Maximilian, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David, van Dam-Nolen, Dianne H K, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil Man, Mendyk, Anne-Marie, Köhler, Sebastian, van Oostenburgge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Regis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Wardlaw, Joanna, Kelly, Peter, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji-Hoe, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Lau, Kui Kai, Jouvent, Eric, Toyoda, Kazunori, Yoshimura, Sohei, Bae, Hee-Joon, Martí-Fàbregas, Joan, Prats-Sánchez, Luis, Lyrer, Philippe, Best, Jonathan, Werring, David, Engelter, Stefan T, Peters, Nils, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
All institutes and research themes of the Radboud University Medical Center, Neurology, Neurology (clinical), Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Abstract

Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023. Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023.

Published
2023

39. Increased Cerebral Small Vessel Disease Burden With Renal Dysfunction and Albuminuria in Patients Taking Antithrombotic Agents: The Bleeding With Antithrombotic Therapy 2

Author

Tanaka, Kanta, primary, Miwa, Kaori, additional, Takagi, Masahito, additional, Sasaki, Makoto, additional, Yakushiji, Yusuke, additional, Kudo, Kohsuke, additional, Shiozawa, Masayuki, additional, Tanaka, Jun, additional, Nishihara, Masashi, additional, Yamaguchi, Yoshitaka, additional, Fujita, Kyohei, additional, Honda, Yuko, additional, Kawano, Hiroyuki, additional, Ide, Toshihiro, additional, Yoshimura, Sohei, additional, Koga, Masatoshi, additional, Hirano, Teruyuki, additional, and Toyoda, Kazunori, additional

Published
2022
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42. Harboring Cnm-Expressing Streptococcus Mutans In The Oral Cavity Relates To Both Deep and Lobar Cerebral Microbleeds

Author

Ikeda, Shuhei, primary, Saito, Satoshi, additional, Hosoki, Satoshi, additional, Tonomura, Shuichi, additional, Yamamoto, Yumi, additional, Ikenouchi, Hajime, additional, Ishiyama, Hiroyuki, additional, Tanaka, Tomotaka, additional, Hattori, Yorito, additional, Friedland, Robert P., additional, Carare, Roxana O., additional, Kuriyama, Nagato, additional, Yakushiji, Yusuke, additional, Hara, Hideo, additional, Koga, Masatoshi, additional, Toyoda, Kazunori, additional, Nomura, Ryota, additional, Takegami, Misa, additional, Nakano, Kazuhiko, additional, and Ihara, Masafumi, additional

Published
2021
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44. Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors

Author

Kataoka, Yuko, Sonoda, Kazutaka, Takahashi, Jun C, Ishibashi-Ueda, Hatsue, Toyoda, Kazunori, Yakushiji, Yusuke, Kusaka, Hirofumi, and Koga, Masatoshi

Subjects
cardiovascular diseases
Abstract

令和3年度, The procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer., We studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson's trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares., Of the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80)., Thromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.

Published
2021

46. 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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47. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis

Author

Martí-Fàbregas, Joan, Camps-Renom, Pol, Best, Jonathan G., Ramos-Pachon, Anna, Guasch-Jiménez, Marina, Martinez-Domeño, Alejandro, Guisado-Alonso, Daniel, Gómez-Ansón, Beatriz M., Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Bae, Hee-Joon, Shiozawa, Masayuki, Koga, Masatoshi, Toyoda, Kazunori, Hennerici, Michael G., Chabriat, Hugues, Jouvent, Eric, Wong, Debbie Yuen Kwun, Mak, Henry, Lau, Kui Kai, Kim, Young Dae, Song, Tae-Jin, Heo, Ji-Hoe, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy A., Nishihara, Masashi, Tanaka, Jun, Hara, Hideo, Yakushiji, Yusuke, Coutts, Shelagh B., Smith, Eric, Polymeris, Alexandros A., Wagner, Benjamin, Seiffge, David, Lyrer, Philippe A., Peters, Nils, Engelter, Stefan T., Al-Shahi Salman, Rustam, Jäger, Hans Rudolf, Lip, Gregory Y.H., Goeldlin, Martina, Panos, Leonidas, Karayiannis, Christopher Charles, Phan, Thanh G., Srikanth, Velandai K., Christ, Nicolas, Gunkel, Sarah, Fluri, Felix, Leung, Thomas W., Soo, Yannie O.Y., Chu, Winnie, Abrigo, Jill, Barbato, Carmen, Browning, Simone, Simister, Robert, Mendyk, Anne-Marie, Bordet, Régis, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Jung, Simon, Necioglu Orken, Dilek, Werring, David, and Prats-Sanchez, Luis

Published
2023
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48. Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage

Author

von der Brelie, Christian, Hadjigeorgiou, Georgios, Tsivgoulis, Georgios, Wilson, Duncan, Katsanos, Aristeidis H., Sargento-Freitas, João, Marques-Matos, Cláudia, Azevedo, Elsa, Adachi, Tomohide, Aizawa, Yoshifusa, Abe, Hiroshi, Tomita, Hirofumi, Okumura, Ken, Hagii, Joji, Seiffge, David J., Lioutas, Vasileios-Arsenios, Traenka, Christopher, Varelas, Panayiotis, Basir, Ghazala, Krogias, Christos, Purrucker, Jan C., Sharma, Vijay K., Rizos, Timolaos, Mikulik, Robert, Sobowale, Oluwaseun A., Barlinn, Kristian, Sallinen, Hanne, Goyal, Nitin, Yeh, Shin-Joe, Karapanayiotides, Theodore, Wu, Teddy Y., Vadikolias, Konstantinos, Ferrigno, Marc, Houben, Rik, Giannopoulos, Sotirios, Schreuder, Floris H. B. M., Chang, Jason J., Perry, Luke A., Mehdorn, Maximilian, Marto, João-Pedro, Pinho, João, Tanaka, Jun, Boulanger, Marion, Al-Shahi Salman, Rustam, Jäger, Hans R., Shakeshaft, Clare, Yakushiji, Yusuke, Choi, Philip M. C., Staals, Julie, Cordonnier, Charlotte, Jeng, Jiann-Shing, Veltkamp, Roland, Dowlatshahi, Dar, Engelter, Stefan T., Parry-Jones, Adrian R., Meretoja, Atte, Mitsias, Panayiotis D., Alexandrov, Andrei V., Ambler, Gareth, Werring, David J., Hadjigeorgiou, Georgios [0000-0001-5386-4273], Tsivgoulis, Georgios [0000-0002-0640-3797], Katsanos, Aristeidis H. [0000-0002-6359-0023], Karapanayiotides, Theodore [0000-0002-2357-7967], Neurologian yksikkö, Department of Neurosciences, Clinicum, MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, and MUMC+: MA Med Staf Spec Neurologie (9)

Subjects
Male, Vitamin K, INTRACRANIAL HEMORRHAGE, Administration, Oral, 030204 cardiovascular system & hematology, VITAMIN-K ANTAGONIST, 3124 Neurology and psychiatry, 0302 clinical medicine, RADIOLOGICAL COURSE, Stroke, Aged, 80 and over, CEREBRAL MICROBLEEDS, Hazard ratio, Middle Aged, Vitamin K antagonist, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Intraventricular hemorrhage, Neurology, Female, STROKE, Adult, medicine.medical_specialty, medicine.drug_class, ANTITHROMBOTIC THERAPY, Neuroimaging, WARFARIN, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Hematoma, Internal medicine, medicine, Humans, cardiovascular diseases, HEMATOMA VOLUME, METAANALYSIS, Aged, Cerebral Hemorrhage, Intracerebral hemorrhage, business.industry, 3112 Neurosciences, Anticoagulants, Odds ratio, medicine.disease, Confidence interval, nervous system diseases, ATRIAL-FIBRILLATION, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

84:702-712. OBJECTIVE: Whether intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOAC-ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA-ICH) is uncertain. METHODS: We performed a systematic review and individual patient data meta-analysis of cohort studies comparing clinical and radiological outcomes between NOAC-ICH and VKA-ICH patients. The primary outcome measure was 30-day all-cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricular hemorrhage extension. RESULTS: We included 7 eligible studies comprising 219 NOAC-ICH and 831 VKA-ICH patients (mean age = 77 years, 52.5% females). The 30-day mortality was similar between NOAC-ICH and VKA-ICH (24.3% vs 26.5% hazard ratio = 0.94, 95% confidence interval [CI] = 0.67-1.31). However, in multivariate analyses adjusting for potential confounders, NOAC-ICH was associated with lower admission National Institutes of Health Stroke Scale (NIHSS) score (linear regression coefficient = -2.83, 95% CI = -5.28 to -0.38), lower likelihood of severe stroke (NIHSS > 10 points) on admission (odds ratio [OR] = 0.50, 95% CI = 0.30-0.84), and smaller baseline hematoma volume (linear regression coefficient = -0.24, 95% CI = -0.47 to -0.16). The two groups did not differ in the likelihood of baseline hematoma volume

Published
2018

50. 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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