Clinical Neurology and Neurosurgery最新文献

{"title":"Risk factors and predictive model for restenosis after endovascular recanalization for chronic internal carotid artery occlusion","authors":"Xiguang Fu ,&nbsp;Haoyu Zhu ,&nbsp;Yuqi Song ,&nbsp;Jiarui Zhang ,&nbsp;Mengyuan Yuan ,&nbsp;Shengjun Sun ,&nbsp;Yong Zhang ,&nbsp;Chuhan Jiang","doi":"10.1016/j.clineuro.2025.109049","DOIUrl":"10.1016/j.clineuro.2025.109049","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence regarding restenosis after successful endovascular recanalization for chronic internal carotid artery occlusion (CICAO) remains limited. This study aimed to investigate the incidence and risk factors of restenosis following technically successful revascularization for CICAO, and to develop a novel risk score for risk stratification.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 204 patients with CICAO who underwent successful endovascular recanalization. The incidence of restenosis was assessed, risk factors were identified through multivariable regression analysis, and a predictive model for restenosis was developed using multivariable regression analysis.</div></div><div><h3>Results</h3><div>During a mean imaging follow-up duration of 16.1 ± 8.5 months, 47 patients (23.5 %) developed internal carotid artery restenosis or reocclusion. A multivariable logistic regression model constructed using backward stepwise regression demonstrated an area under the curve values of 0.758 in the training set and 0.757 in the test set. The model identified three independent risk factors: internal carotid artery tortuosity, non-tapered stump morphology, and residual stenosis &gt; 30 %.</div></div><div><h3>Conclusion</h3><div>This study demonstrated a restenosis rate of 23.5 % following successful endovascular recanalization for CICAO. Internal carotid artery tortuosity, non-tapered stump morphology, and residual stenosis &gt; 30 % were identified as independent predictors of restenosis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109049"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiologies, pathogenesis and clinical outcomes associated with spinal cord infarction: Systematic review","authors":"Zahra Khosravi ,&nbsp;Katarzyna Minta ,&nbsp;Lena Mary Houlihan ,&nbsp;Chandrasekaran Kaliaperumal","doi":"10.1016/j.clineuro.2025.109041","DOIUrl":"10.1016/j.clineuro.2025.109041","url":null,"abstract":"<div><h3>Background</h3><div>Spinal cord infarction (SCI) is a rare condition caused by ischemic injury leading to spinal cord cell death. Its diverse aetiologies, combined with the spinal cord’s intricate vascular anatomy, present diagnostic and surgical challenges. Despite its rarity, comprehensive research is warranted to inform future diagnostic and management protocols.</div></div><div><h3>Methods</h3><div>A systematic review adhering to PRISMA 2020 guidelines was conducted to analyse SCIs over a 25-year period (1998–2023). Data from PubMed, Ovid MEDLINE and Google Scholar were included from case reports, case studies and literature reviews, with the paediatric population being excluded.</div></div><div><h3>Results</h3><div>Of 200 articles, 21 studies were analysed, evaluating 734 patients. SCI showed a male predominance (60.1 %) and a mortality rate of 8.4 %. The most frequent complication was urinary or faecal incontinence (36.3 %). Key aetiologies included cardiovascular (13.6 %), peri-/post-procedural (12.4 %), and cryptogenic causes (5.8 %). 43.9 % of cases were treated medically, while 6.1 % were managed with lumbar drains. ASIA scores at onset revealed: A (30.6 %), B (23.8 %), C (21.4 %) and D (25.2 %).</div></div><div><h3>Conclusions</h3><div>SCI poses significant morbidity and mortality. Of note, aortic diseases and cardiovascular factors are critical contributors. MRI, particularly DWI, remains crucial for diagnosis. However, treatment lacks standardisation due to limited data and delayed diagnoses. Current therapies range from antiplatelets to innovative surgical approaches, but further research is essential to develop evidence-based practices and refined protocols for enhancing patient outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109041"},"PeriodicalIF":1.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune glial fibrillary acidic protein astrocytopathy – The benefit of early diagnosis and initiation of therapy: A case report","authors":"Ikechukwu Chukwuocha ,&nbsp;Shilpi Shukla ,&nbsp;Smriti Bose ,&nbsp;Simon Ubben ,&nbsp;Tom Hayton ,&nbsp;Tonny Veenith ,&nbsp;Saiju Jacob","doi":"10.1016/j.clineuro.2025.109047","DOIUrl":"10.1016/j.clineuro.2025.109047","url":null,"abstract":"<div><div>We describe a teenage lady who presented with headache, fever, neck stiffness, torticollis, progressive disturbance of consciousness as well as hemodynamic instability and subsequently developed quadriparesis. CSF revealed lymphocytic pleocytosis, elevated protein and low glucose with negative microbial studies. Her clinical course was complicated by acute encephalopathy requiring ITU admission and intubation. Full neuroaxis MRI revealed focal cerebritis with perivenular radial enhancement, and a non-enhancing longitudinally extensive myelitis. Positive Autoimmune glial fibrillary acidic protein (GFAP) IgG was subsequently identified in the CSF via immunofluorescence (IF) assay. CT thorax, abdomen and pelvis was negative for neoplasms. She was initially treated with pulsed intravenous corticosteroids with minimal improvement; however, following plasmapheresis she made a complete recovery of her neurological function. Long-term treatment consisted of oral prednisolone taper and azathioprine to lower the risk of early relapse. GFAP astrocytopathy is a novel autoimmune disease of the central nervous system. It is especially easy to misdiagnose and as such it is imperative to recognize the clinical spectrum of this disorder as early detection and treatment should improve prognosis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109047"},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Modic change grade is associated with patient-reported outcomes in lumbar spinal stenosis surgery","authors":"Peter Muhareb Udby ,&nbsp;Michael T. Modic ,&nbsp;Thomas Vestergaard ,&nbsp;Leah Y. Carreon","doi":"10.1016/j.clineuro.2025.109052","DOIUrl":"10.1016/j.clineuro.2025.109052","url":null,"abstract":"<div><h3>Study design</h3><div>Registry-based cohort study.</div></div><div><h3>Objective</h3><div>To evaluate the impact of the Modic Change Grade (MCG) on patient-reported outcomes (PROs) in patients undergoing lumbar spinal stenosis (LSS) surgery.</div></div><div><h3>Method</h3><div>A register-based cohort study was performed. Lumbar MRIs were graded based on the vertical extent of vertebral body MC involvement with MCG-A (&lt;25 %), MCG-B (25–50 %), and MCG-C (&gt;50 %). Patients were divided into two groups: Minor MC (MCG-A) and Major MC (MCG-B+). PROs, including the Visual Analogue Scale for back pain (VAS-BP), leg pain (VAS-LP), and Oswestry Disability Index (ODI), were collected.</div></div><div><h3>Results</h3><div>Of 208 patients included, there was no significant difference in preoperative PROs. At two-year follow-up, patients with major MC had significantly worse mean VAS-BP (32 vs 44, p = 0.045), VAS-LP (27 vs 45, p = 0.003), and ODI scores (22 vs 30, p = 0.036) compared to patients with minor MC.</div></div><div><h3>Conclusion</h3><div>This is the first study to evaluate the association between MCG and PROs in patients undergoing LSS surgery. Major MC was associated with significantly worse pain and disability scores at two-year follow-up. Future studies should incorporate the MCG to further investigate the potential impact of MC phenotypes on PROs.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109052"},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of external ventricular drain placement and its effects on in-hospital outcomes in traumatic brain injury: A propensity score-matched analysis","authors":"Sam H. Jiang ,&nbsp;Hadeel M. Mansour ,&nbsp;Michael Edgar ,&nbsp;Gabriel S. Gonzales-Portillo ,&nbsp;Zayed Almadidy ,&nbsp;Ankit I. Mehta","doi":"10.1016/j.clineuro.2025.109044","DOIUrl":"10.1016/j.clineuro.2025.109044","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with traumatic brain injury (TBI) often develop elevated intracranial pressure (ICP) and require emergency external ventricular drain (EVD) placement to decompress the cerebral ventricles. In patients who are initially stable, elevated ICP may develop later during hospitalization, necessitating delayed EVD placement. In these patients, it is unclear if early empiric placement can help reduce mortality. The purpose of this study is to compare the differences in in-hospital outcomes between delayed and early EVD placement.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, the National Trauma Data Bank was queried from 2017 to 2019 for all adults with TBI who underwent EVD placement. Late placement was defined as placement longer than the 75 % percentile (13.8 h). Patients in the early and late groups were propensity-score matched based on patient demographics, comorbidities, injury severity, and hospital trauma level. Group differences were compared using t-tests and chi-squared tests. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality.</div></div><div><h3>Results</h3><div>A total of 6249 patients were included, of which 4686 underwent early and 1563 underwent late placement. Following matching, the late group had comparable rates of mortality (34.54 % vs. 32.91 %, P = .62) and length of stay (LOS; 23.62 vs. 20.85 days, P = .1), but longer intensive care unit LOS (15.72 vs. 13.33 days, P &lt; .01) and ventilator duration (13.41 vs. 10.1 days, P &lt; .01) and higher rates of stroke (6.13 % vs. 4.15 %, P &lt; .01) and unplanned intubation (10.37 % vs. 4.87 %, P &lt; .01). On multivariable regression analysis, EVD timing was not an independent predictor of in-hospital mortality (OR 1, CI 0.99–1.01).</div></div><div><h3>Conclusions</h3><div>Given the comparable mortality rates between early and late EVD placement, a flexible, patient-centered approach to EVD timing that prioritizes individualized clinical indications may be superior to rigid timing protocols or empiric EVD placement in TBI.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109044"},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open skull fractures and sepsis: Evidence towards a targeted antibiotic prophylactic recommendation","authors":"Josias P. Hoffman ,&nbsp;Adriaan J. Vlok ,&nbsp;Ruan Grobler","doi":"10.1016/j.clineuro.2025.109050","DOIUrl":"10.1016/j.clineuro.2025.109050","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Although patients with weapon-induced open skull fractures benefit from antibiotic prophylaxis, there is limited data on microbiological factors associated with such injuries. This study considers the most prominent bacteria cultured, alongside their antibiotic resistance profiles and factors relating to wound infection for insights into a targeted clinical management recommendation in patients suffering from assault-related open skull fractures.</div></div><div><h3>Methods</h3><div>Patients with weapon-induced traumatic head injuries and infective complications were analysed (n = 108) regarding factors impacting the peri-operative period, bacterial samples cultured, and the associated clinical outcomes, together with antibiotic susceptibility testing for all bacterial cultures. The relevant variables were analysed using descriptive statistics and a Pearson Chi-Square statistical test.</div></div><div><h3>Results</h3><div>Antibiotic prophylaxis significantly reduced infective complications in open skull fractures. <em>Staphylococcus aureus</em>, <em>Streptococcus</em> spp<em>., Acinetobacter baumanii, Enterobacter</em> spp., and <em>Enterococcus</em> spp. were the main organisms cultured in the wounds in this study population. Scalp tissue specimens produced the most positive culture rates (84.6 %). Within post-operative clinical outcomes, <em>S. aureus</em>-culture positive patients were associated with developing systemic sepsis, or a superficial wound infection. Patients with positive <em>Streptococcus</em> spp. or <em>A. baumanii</em> cultures were more likely to be associated with developing systemic sepsis, whereas <em>Enterobacter</em> spp. and <em>Enterococcus</em> spp. was not associated with a particular infective complication subtype. Antibiotic resistance comparable with the international resistance profiles was noted in <em>S. aureus</em>, <em>Enterobacter</em> spp. and <em>A. baumanii</em>.</div></div><div><h3>Conclusion</h3><div>Key factors for consideration are highlighted and the use of Cefazolin and Gentamycin as targeted antibiotic prophylaxis in patients with traumatic head injuries following weapon assault is recommended.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109050"},"PeriodicalIF":1.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144597187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with complications in reversible cerebral vasoconstriction syndrome: A seven-year study at a comprehensive stroke center","authors":"Constance McGraw ,&nbsp;John Peralta ,&nbsp;Yasaman Pirahanchi ,&nbsp;Christian Burrell ,&nbsp;Amy Nieberlein ,&nbsp;David Bar-Or ,&nbsp;Russell Bartt","doi":"10.1016/j.clineuro.2025.109048","DOIUrl":"10.1016/j.clineuro.2025.109048","url":null,"abstract":"<div><h3>Objective</h3><div>A small subset of patients with reversible cerebral vasoconstriction syndrome (RCVS) experience serious complications and poor outcomes. The objective of this study was to identify demographic and clinical factors associated with complications in RCVS.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults (≥18 years) admitted with RCVS to a comprehensive stroke center between 2016 and 2023. Patient characteristics, serious complications (subarachnoid hemorrhage [SAH], intracerebral hemorrhage, ischemic stroke, reversible cerebral edema, or seizure), and discharge outcomes were analyzed. Patients were stratified by sex. Univariate logistic regression assessed associations between clinical variables and discharge disposition.</div></div><div><h3>Results</h3><div>Among 35 patients (75 % female, median age 44 years), 57 % experienced a serious complication, most commonly SAH (34 %) and ischemic stroke (29 %). Patients with complications were more often female (90 % vs. 53 %, p = 0.02), had longer hospital stays (median 9 vs. 3 days, p = 0.005), received more verapamil (p = 0.005), and were less frequently discharged home (65 % vs. 100 %, p = 0.01). Females had higher rates of complications than males (69 % vs. 22 %, p = 0.02), especially ischemic stroke (38 % vs. 0 %, p = 0.04). Discharge home was more likely in younger patients and those with lower rates of hyperlipidemia (HLD), fewer focal neurologic deficits, and less steroid use. HLD (OR 20.25, p = 0.02), steroid use (OR 11.11, p = 0.02), and focal deficits (OR 11.50, p = 0.01) predicted discharge to a facility.</div></div><div><h3>Conclusion</h3><div>Despite overall positive clinical outcomes, a higher rate of serious complications in women, particularly ischemic strokes, warrants further investigation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109048"},"PeriodicalIF":1.8,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Gentamicin irrigation for the prevention of surgical site infection in brain surgery: A randomized controlled study","authors":"Ittipon Gunnarut ,&nbsp;Kritsada Buakate ,&nbsp;Nisarat Phatisuwan","doi":"10.1016/j.clineuro.2025.109045","DOIUrl":"10.1016/j.clineuro.2025.109045","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative surgical site infections (SSIs) in neurosurgery remain a significant concern due to their associated high morbidity and mortality. Consequently, implementing the most effective preventive measures is essential. One such strategy, intraoperative antibiotic irrigation, has been widely employed; however, its efficacy continues to be debated. Numerous studies have examined the use of various antibiotics, including streptomycin, bacitracin, gentamicin, rifamycin, amikacin, and vancomycin. Among these, gentamicin has shown promising results in reducing SSI rates, although other antibiotics have also demonstrated potential. Further research is required to determine the most effective method for minimizing SSIs in neurosurgical procedures.</div></div><div><h3>Objective</h3><div>To compare the postoperative outcomes of gentamicin irrigation versus normal saline irrigation in the prevention of surgical site infections (SSIs) in neurosurgical procedures.</div></div><div><h3>Method</h3><div>A prospective randomized controlled trial was conducted at Rajavithi Hospital between 2023 and 2025. A total of 136 patients were enrolled and randomly assigned, using a block-of-four randomization method, into two groups: the gentamicin irrigation group (n = 68) and the normal saline irrigation group (n = 68). Postoperative surgical site infection (SSI) rates were monitored and statistically analyzed.</div></div><div><h3>Results</h3><div>A total of 136 patients were included in this study, with 68 patients (50 %) receiving gentamicin irrigation and 68 patients (50 %) receiving normal saline irrigation. There were no statistically significant differences between the two groups in terms of sex, age, body weight, underlying conditions, operative status, complications, operative time, length of hospital stay, or disease type. The postoperative surgical site infection (SSI) rate was 6 % in both groups (4 patients each; p = 0.443). In the gentamicin irrigation group, wound infection grade 3 was observed in 2 patients (3 %), and grade 4 in another 2 patients (3 %). In the normal saline group, 4 patients (6 %) developed grade 4 wound infections.</div></div><div><h3>Conclusion</h3><div>Gentamicin irrigation did not demonstrate a significant advantage over normal saline irrigation in preventing postoperative surgical site infections when intravenous antibiotics were concurrently administered in neurosurgical patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109045"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144597185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A re-analysis of cranioplasty timing following craniectomy with balanced laboratory confounders","authors":"Yu-Chieh Chen,&nbsp;Joshua Wang","doi":"10.1016/j.clineuro.2025.109046","DOIUrl":"10.1016/j.clineuro.2025.109046","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109046"},"PeriodicalIF":1.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of intravenous tenecteplase compared with alteplase for mild acute ischemic stroke","authors":"Yan Qin ,&nbsp;Longhai Zhu ,&nbsp;Xiaoting Han ,&nbsp;Tingting Kang ,&nbsp;Yongjun Cao ,&nbsp;Tao Xu ,&nbsp;Jijun Shi","doi":"10.1016/j.clineuro.2025.109038","DOIUrl":"10.1016/j.clineuro.2025.109038","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the short-term outcomes of intravenous tenecteplase compared with alteplase for patients with mild acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5 points).</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 226 mild stroke patients in the Stroke Center Registry database who received intravenous thrombolysis from May 2010 to December 2023. The primary outcome was excellent functional prognosis (modified Rankin scale [mRS] score of 0–1) at discharge. The secondary outcomes were good prognosis (mRS 0–2) at discharge, early neurological improvement (ENI), early neurological deterioration (END), all intracranial hemorrhage and symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analyses were used to assess the independent factors of excellent outcome and END.</div></div><div><h3>Results</h3><div>Excellent functional outcome at discharge occurred in 82.8 % of patients receiving tenecteplase and 56.4 % of patients receiving alteplase (adjusted OR 3.59, 95 % CI 1.62–7.97; <em>P</em> <em>=</em> 0.002). With respect to secondary outcomes, similar rates of good outcome, ENI, END, all intracranial hemorrhage and sICH were observed between the two groups before and after adjusting for confounding factors (all <em>P</em> &gt; 0.05). Multivariate logistic regression analysis revealed that the door-to-needle time (DNT), baseline NIHSS score, and END were negatively associated with excellent outcome, and ENI was positively associated with excellent outcome. In addition, only DNT was independently associated with END (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Tenecteplase was associated with a higher rate of excellent functional outcome at discharge compared to alteplase for mild stroke patients treated within 4.5 h of symptom onset.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109038"},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}