IMPORTANCEWhether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear.OBJECTIVE To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in DESIGN, SETTING, AND PARTICIPANTS

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trial fibrillation (AF) is a common arrhythmia that represents an independent and evident risk factor for systemic embolism, particularly ischemic stroke, and exerts a significant impact on post-stroke mortality. Interestingly, stroke caused by AF displays distinctive features, such as severe neurological deficits, disability and high mortality, 1 so AF is likely to play an important role in the etiology of perioperative and in-hospital-onset stroke. 2,3 Given the evidence accumulated over the past decade, AF seems to be becoming a greater public health burden and crucial problem for the social welfare of populations of advancing age.The prevalence of AF in adults ≥40 years old is reportedly 0.7% in Korea, which has largely maintained a traditional Asian lifestyle, and 2.3% in the United States. 4,5 In previous population-based studies, 2 implications have been identified: (1) AF is more frequent in men than in women in each generation; and (2) the prevalence of AF increases with age. Indeed, the prevalence of AF has been investigated in several countries, but many epidemiological uncertainties remain, particularly the prevalence in Japanese populations.Circulation Journal Vol.72, June 2008 In this analysis, the Kurashiki Annual Medical Survey (KAMS) was used to investigate the prevalence and clinical factors associated with AF in a large community-based epidemiological study. MethodsThe KAMS study is a prospective population-based investigation of risk factors for AF in men and women aged ≥40 year old. We enrolled the 246,246 adult residents in Kurashiki-city who received an official mail request to participate in a screening health test from May to December 2006. The Kurashiki-city Public Health Center did not send this notification to employees of government, private companies, offices and factories because the Labor Standards Law has regulated that employers should survey the heath of their employees. After excluding residents who were employees, a total of 41,436 residents (mean age, 72.1±11.3 years; 13,963 men) participated in the KAMS study.All participants answered questions on history of illness (hypertension, diabetes mellitus, hypercholesterolemia, cardiac disease, renal dysfunction and liver disease) and smoking status, and underwent physical examinations including blood pressure, electrocardiography (ECG), and blood testing (total cholesterol, triglycerides, fasting glucose and hemoglobin A1c). Body mass index was calculated as weight in kilograms divided by height in meters squared. Arterial blood pressure was carefully measured in the arm with the patient seated after resting for a few minutes, following the Guidelines of Elders' Welfare and Health in Kurashiki-city.

Background and Purpose-We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. Methods-We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2-4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3-to 6-month functional outcome (modified Rankin score >2). We performed a large-scale pooled individual patient data meta-analysis of quality observational studies to test the following hypotheses: (1) there is a relationship between increasing CMB burden and ICH risk 8,9 ; (2) strictly lobar CMBs (reflecting possible or probable cerebral amyloid angiopathy [CAA]) and mixed or strictly deep CMBs (likely associated with hypertensive arteriopathy) have different effects on ICH risk; (3) CMBs are associated more strongly with the risk of remote ICH than other ICH types 10 ; and (4) CMBs are associated with worse functional outcome. Results-In Methods Study Design and Inclusion CriteriaWe identified prospective or retrospective studies that assessed pretreatment MRI-defined CMBs, ICH, and 3-to 6-month functional outcome after acute ischemic stroke, treated solely with intravenous tPA from a systematic review prepared according to Preferred Reporting Items for Systematic Review and Meta-Analyses 7,11 (updated August 1, 2015). We searched PubMed for micro(-)bleed*, or micro(-)h(a) emorrhag*, or gradient-echo, or susceptibility-weighted in association with thromboly* or tPA, or tissue plasminogen activator 7 ; reference lists; and authors' own files. Figure I in the online-only Data Supplement shows a flow diagram.We collected anonymized individual patient detailed clinical data and CMB counts in lobar, deep, and infratentorial regions according to standardized definitions 6,12,13 using standardized report forms. A prespecified protocol was circulated to collaborators but not published. OutcomesWe defined ICH according to ECASS-2 (European Cooperative Acute Stroke Study II), 14,15 including hemorrhagic infarction, parenchymal hemorrhage (PH), and sICH 16 (acute intracerebral blood and associated increase in National Institutes of Health Stroke Scale ≥4 points, except 1 study 17 that used the definition in the PROACT-II trial [Prolyse in Acute Cerebral Thromboembolism]).18 Remote parenchymal hemorrhage (PHr) was defined as ICH remote from the symptomatic ischemic area. 10 We defined poor outcome at 3 to 6 months as modified...