دورية أكاديمية
Intravenous Thrombolysis in Patients With White Matter Hyperintensities in the WAKE-UP Trial
| العنوان: | Intravenous Thrombolysis in Patients With White Matter Hyperintensities in the WAKE-UP Trial |
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| المؤلفون: | Frey, Benedikt, M., Shenas, Farhad, Boutitie, Florent, Cheng, Bastian, Cho, Tae-Hee, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen, Fiehler, Jens, Galinovic, Ivana, Barow, Ewgenia, Königsberg, Alina, Schlemm, Eckhard, Pedraza, Salvador, Lemmens, Robin, Thijs, Vincent, Muir, Keith W., Nighoghossian, Norbert, Simonsen, Claus Ziegler, Gerloff, Christian, Thomalla, Götz |
| المساهمون: | Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf Hamburg (UKE), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Service de Biostatistiques Lyon, Hospices Civils de Lyon (HCL), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Charité - UniversitätsMedizin = Charité - University Hospital Berlin, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta - Girona Biomedical Research Institute (IDIBGI), University Hospitals Leuven Leuven, Catholic University of Leuven = Katholieke Universiteit Leuven (KU Leuven), University of Melbourne, Austin Hospital Melbourne, Austin Health, Victorian Infectious Diseases Reference Laboratory Melbourne, Australia (VIDRL), University of Glasgow, Institute of Neurosciences and Psychology Glasgow, Aarhus University Hospital, WAKE-UP Investigators |
| المصدر: | ISSN: 0039-2499. |
| بيانات النشر: | HAL CCSD American Heart Association |
| سنة النشر: | 2023 |
| المجموعة: | Université Jean Monnet – Saint-Etienne: HAL |
| مصطلحات موضوعية: | alteplase, cerebral small vessel disease, ischemic stroke, thrombolytic therapy, [SDV]Life Sciences [q-bio] |
| الوصف: | International audience ; BACKGROUND: White matter hyperintensities of presumed vascular origin (WMH) are the most prominent imaging feature of cerebral small vessel disease (cSVD). Previous studies suggest a link between cSVD burden and intracerebral hemorrhage and worse functional outcome after thrombolysis in acute ischemic stroke. We aimed to determine the impact of WMH burden on efficacy and safety of thrombolysis in the MRI-based randomized controlled WAKE-UP trial of intravenous alteplase in unknown onset stroke. METHODS: The design of this post hoc study was an observational cohort design of a secondary analysis of a randomized trial. WMH volume was quantified on baseline fluid-attenuated inversion recovery images of patients randomized to either alteplase or placebo in the WAKE-UP trial. Excellent outcome was defined as score of 0-1 on the modified Rankin Scale after 90 days. Hemorrhagic transformation was assessed on follow-up imaging 24-36 hours after randomization. Treatment effect and safety were analyzed by fitting multivariable logistic regression models. RESULTS: Quality of scans was sufficient in 441 of 503 randomized patients to delineate WMH. Median age was 68 years, 151 patients were female, and 222 patients were assigned to receive alteplase. Median WMH volume was 11.4 mL. Independent from treatment, WMH burden was statistically significantly associated with worse functional outcome (odds ratio, 0.72 [95% CI, 0.57-0.92]), but not with higher chances of any hemorrhagic transformation (odds ratio, 0.78 [95% CI, 0.60-1.01]). There was no interaction of WMH burden and treatment group for the likelihood of excellent outcome (P=0.443) or any hemorrhagic transformation (P=0.151). In a subgroup of 166 patients with severe WMH, intravenous thrombolysis was associated with higher odds of excellent outcome (odds ratio, 2.40 [95% CI, 1.19-4.84]) with no significant increase in the rate of hemorrhagic transformation (odds ratio, 1.96 [95% CI, 0.80-4.81]). CONCLUSIONS: Although WMH burden is associated ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/37226772; inserm-04431828; https://inserm.hal.science/inserm-04431828Test; https://inserm.hal.science/inserm-04431828/documentTest; https://inserm.hal.science/inserm-04431828/file/Stroke2023_FreyBM.pdfTest; PUBMED: 37226772 |
| DOI: | 10.1161/strokeaha.122.040247 |
| الإتاحة: | https://doi.org/10.1161/strokeaha.122.040247Test https://inserm.hal.science/inserm-04431828Test https://inserm.hal.science/inserm-04431828/documentTest https://inserm.hal.science/inserm-04431828/file/Stroke2023_FreyBM.pdfTest |
| رقم الانضمام: | edsbas.E6D71B6E |
| قاعدة البيانات: | BASE |
| DOI: | 10.1161/strokeaha.122.040247 |
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