Yamazaki Naoya, Koga Masatoshi, Doijiri Ryosuke, Inoue Manabu, Miwa Kaori, Yoshimura Sohei, Fukuda-Doi Mayumi, Aoki Junya, Asakura Koko, Sasaki Makoto, Kitazono Takanari, Kimura Kazumi, Minematsu Kazuo, Yamamoto Haruko, Ihara Masafumi, Toyoda Kazunori
Department of Neurology, Iwate Prefectural Central Hospital.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center.
Circ J. 2024 Feb 22;88(3):382-387. doi: 10.1253/circj.CJ-23-0662. Epub 2024 Jan 13.
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.
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.
When an MRI-guided approach is used, CE patients with unknown time of onset appear to be suitable candidates for thrombolysis.
我们研究了磁共振成像（MRI）引导下静脉溶栓治疗发病时间不明的心源性栓塞性卒中（CE）患者的临床效果。
THAWS试验的这项亚分析评估了0.6mg/kg阿替普酶治疗发病时间不明且弥散加权成像-液体衰减反转恢复序列不匹配的CE患者的疗效和安全性。急性期采用SSS-TOAST分类系统将患者分为CE组和非CE组。疗效指标为90天时改良Rankin量表评分为0-1分。THAWS试验中的126例患者纳入本研究，其中45例（35.7%）被诊断为CE。在CE组中，阿替普酶组获得良好预后的患者在数量上多于对照组（52%对35%；调整后的优势比[aOR]2.25；95%置信区间[CI]0.50-9.99）。然而，在非CE组中，阿替普酶组和对照组的良好预后相当（分别为44%和55%；aOR 0.39；95%CI 0.12-1.21）。CE组和非CE组之间，治疗队列交互作用对良好预后的影响有一定显著性（P=0.069）。在CE组中，溶栓后无患者发生症状性颅内出血（ICH）或Ⅱ型脑实质血肿。
采用MRI引导方法时，发病时间不明的CE患者似乎是溶栓的合适人选。
