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

作者：Naruhiko Kamogawa, Kaori Miwa, Ḱazunori Toyoda, Märit Jensen, Manabu Inoue, Sohei Yoshimura, Mayumi Fukuda‐Doi, Takanari Kitazono, Florent Boutitie, Henry Ma, Peter A. Ringleb, Ona Wu, Lee H. Schwamm, Steven Warach, Werner Hacke, Stephen M. Davis, Geoffrey A. Donnan, Christian Gerloff, Götz Thomalla, Masatoshi Koga, Bastian Cheng, Martin Bendszus, Christopher Bladin, Leonid Churilov, Brunce Campbell, Mark Parsons, Nawaf Yassi, Martin Ebinger, Matthias Endres, Jochen B. Fiebach, Timothy Kleinig, Lawrence L. Latour, Robin Lemmens, Christopher Levi, Didier Leys, Carlos A. Molina, Keith W. Muir, Norbert Nighoghossian, Salvador Pedraza, Peter D. Schellinger, Stefan Schwab, Claus Z. Simonsen, Shlee Song, Vincent Thijs, Danilo Toni, Chung Y. Hsu, Nils Wahlgren · 发表于：Stroke · 年份：2024 · DOI：10.1161/strokeaha.123.043358 · 被引用次数：10 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Stroke Rehabilitation and Recovery

BACKGROUND: Stroke with unknown time of onset can be categorized into 2 groups; wake-up stroke (WUS) and unwitnessed stroke with an onset time unavailable for reasons other than wake-up (non–wake-up unwitnessed stroke, non-WUS). We aimed to assess potential differences in the efficacy and safety of intravenous thrombolysis (IVT) between these subgroups. METHODS: Patients with an unknown-onset stroke were evaluated using individual patient-level data of 2 randomized controlled trials (WAKE-UP [Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke], THAWS [Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg]) comparing IVT with placebo or standard treatment from the EOS (Evaluation of Unknown-Onset Stroke Thrombolysis trial) data set. A favorable outcome was prespecified as a modified Rankin Scale score of 0 to 1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage at 22 to 36 hours and 90-day mortality. The IVT effect was compared between the treatment groups in the WUS and non-WUS with multivariable logistic regression analysis. RESULTS: Six hundred thirty-four patients from 2 trials were analyzed; 542 had WUS (191 women, 272 receiving alteplase), and 92 had non-WUS (42 women, 43 receiving alteplase). Overall, no significant interaction was noted between the mode of onset and treatment effect ( P value for interaction=0.796). In patients with WUS, the frequencies of favorable outcomes were 54.8% and 45.5% in the I...