International Journal of Stroke最新文献

{"title":"The first-ever World Health Organisation (WHO) resolution on stroke, climate change and stroke, and do illicit drugs increase stroke risk.","authors":"Hugh S Markus","doi":"10.1177/17474930261455412","DOIUrl":"10.1177/17474930261455412","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"21 6","pages":"732-734"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the association of cannabis use and stroke frequency-dependent: A cross-sectional analysis of the NIH all of us research program.","authors":"Ethan Dl Brown, Barnabas Obeng-Gyasi, Seung Won Jeong, Daniel Schneider, Aladine A Elsamadicy, Evan Luther, Richard Libman, Jeffrey M Katz, Timothy G White","doi":"10.1177/17474930251396481","DOIUrl":"10.1177/17474930251396481","url":null,"abstract":"<p><strong>Background: </strong>The relationship between cannabis use and stroke prevalence remains incompletely characterized, with most studies limited by binary exposure classification. We examined the frequency-dependent association of cannabis use and stroke prevalence by subtype in a large, diverse national cohort.</p><p><strong>Aims: </strong>Our primary aim was to explore the relationship between cannabis use frequency and the adjusted prevalence of ischemic and hemorrhagic stroke.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of 122,767 adults from the National Institutes of Health (NIH) <i>All of Us</i> Research Program who completed lifestyle surveys between 2017-2022. Cannabis use frequency was stratified into five categories: never, once or twice, monthly, weekly, and daily. Ischemic and hemorrhagic stroke diagnoses were identified using International Classification of Diseases (ICD) 9 and 10 codes. Multivariable logistic regression models were adjusted for age, sex, race/ethnicity, obesity, type 2 diabetes, alcohol, and tobacco use.</p><p><strong>Results: </strong>Among 122,767 participants, 2,765 (2.3%) had a history of stroke. After multivariable adjustment, a significant frequency-dependent association was found for ischemic stroke; compared to never-users, \"once or twice\" use was associated with a 10% increased odds (adjusted odds ratio (aOR) = 1.10, confidence interval (CI) = 0.95-1.26), monthly use with a 3% reduced odds (aOR = 0.97, CI = 0.73-1.29), weekly use with a 45% increased odds (aOR = 1.45, 95% CI = 1.19-1.77), and daily use with a 48% increased odds (aOR = 1.48, 95% CI = 1.26-1.74). In contrast, the odds of hemorrhagic stroke were elevated across all frequencies of cannabis use, with the highest odds observed in monthly users (aOR = 1.74, 95% CI = 1.21-2.51). These subtype-specific associations contributed to an overall increased odds of any stroke for weekly (aOR = 1.39) and daily (aOR = 1.44) users.</p><p><strong>Conclusions: </strong>In this large, nationally representative study, cannabis use was associated with stroke through two distinct, subtype-specific patterns. Odds of ischemic stroke demonstrated a clear dose-response relationship concentrated among frequent (weekly or daily) users, while odds of hemorrhagic stroke were elevated across all frequencies of use. These findings highlight the need to incorporate detailed cannabis use assessment into routine cerebrovascular risk stratification.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"815-826"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty index changes before and after stroke: Findings from four cohorts covering 18 countries.","authors":"Congdi Wang, Xiaoyu Qian, Xueman Zhao, Min Jin, Cunxian Jia, Feifei Jia","doi":"10.1177/17474930251396655","DOIUrl":"10.1177/17474930251396655","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a dynamic predictor of adverse stroke outcomes, but its bidirectional relationship with stroke-how frailty progresses before and after stroke-remains underexplored.</p><p><strong>Aims: </strong>This study aims to examine longitudinal frailty index (FI) trajectories in individuals with and without stroke, and changes in frailty trajectories within individuals before and after a stroke event across four international longitudinal studies.</p><p><strong>Methods: </strong>This prospective cohort study analyzed data from four longitudinal cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), and Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty progression was assessed using validated FI scores. Incident strokes were identified through self-reported doctor diagnoses. Linear mixed models were used to evaluate changes in FI before and after stroke.</p><p><strong>Results: </strong>Among the 73,961 participants, 4374 (5.9%) incident stroke events were identified. Compared to stroke-free individuals, stroke survivors exhibited an observable increase in FI prior to the stroke event (e.g.</p><p><strong>Charls: </strong>β = 0.016/year, 95% confidence interval (CI): 0.014-0.017). A sharp increase in FI occurred during the incident stroke event (HRS: β = 0.078, 95% CI: 0.074-0.083), followed by sustained post-stroke acceleration (ELSA: β = 0.019/year, 95% CI: 0.016-0.022). Sensitivity analyses confirmed robustness across cohorts.</p><p><strong>Conclusion: </strong>Frailty accelerates significantly both before and after an incident stroke, suggesting a bidirectional relationship between stroke and frailty. Integrating frailty assessment into stroke risk stratification, rehabilitation, and secondary prevention to optimize patient outcomes, particularly in aging populations.Data access statement:The datasets generated and analyzed during the current study are available on the HRS website (https://hrs.isr.umich.edu/), CHARLS (https://charls.pku.edu.cn/en), SHARE (https://share-eric.eu/), and ELSA (https://www.elsa-project).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"871-878"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing engagement of people with lived experience of stroke in recovery and rehabilitation research: Consensus-based core recommendations from the fourth Stroke Recovery and Rehabilitation Roundtable.","authors":"Elizabeth A Lynch, Felicity As Bright, Saran Chamberlain, Adewale Adebajo, Pauline Campbell, Donna T Chen, Coralie K English, Ian D Graham, Jytte Isaksen, Molly X Manning, Sidhiprada Mohapatra, Michelle Nelson, Katie Nesbitt, Torsten Rackoll, Shamala Thilarajah, Steven Zeiler, Lisa Kidd","doi":"10.1177/17474930261466091","DOIUrl":"10.1177/17474930261466091","url":null,"abstract":"<p><strong>Rationale: </strong>There is a growing recognition of the importance of engaging with people with lived experience (PWLE) to support research relevance and impact. However, there is little specific guidance for stroke recovery and rehabilitation researchers about how best to engage with PWLE of stroke in research, who face additional barriers to engaging due to common post-stroke sequelae including communication and cognitive difficulties, sensory and perceptual impairments, emotional wellbeing, and fatigue. The aim of this roundtable was to develop recommendations to support researchers to engage with PWLE of stroke in primary and secondary research conducted in laboratory, clinical, health system, or community settings.</p><p><strong>Methods: </strong>We convened an interdisciplinary, international taskforce comprising researchers and lived experience experts (n = 16) to create recommendations to support researchers to engage with PWLE of stroke meaningfully and respectfully. Guided by priorities and key gaps identified by taskforce members, and underpinned by gray and published literature, we formed discrete workgroups to develop consensus-based recommendations and guidance documents addressing common barriers to engagement in stroke research. The recommendations and guides were reviewed, and consensus was reached during a 2-day hybrid in-person/online meeting of the taskforce. These were further refined through consultation with international experts in research engagement.</p><p><strong>Results: </strong>We created the EMBED (Engaging Meaningfully to Build research with people with lived experience to drive improvements in stroke research) framework, consisting of five consensus recommendations: Select the engagement approach; Identify people to engage with; Embed accessible and inclusive ways of working; Support and strengthen accessibility and inclusivity; and Report accessibility and inclusivity. Ten guidance documents provide practical support to researchers to engage with PWLE of stroke in all research settings.</p><p><strong>Conclusions: </strong>The EMBED framework provides researchers with pragmatic and structured support to engage with PWLE in stroke research.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261466091"},"PeriodicalIF":6.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in South Asian populations: Unique susceptibility, risk factors, and treatment considerations.","authors":"Alexis E Giff, Mansi Totwani, Hector W Cure, Aneesh B Singhal","doi":"10.1177/17474930261463480","DOIUrl":"10.1177/17474930261463480","url":null,"abstract":"<p><p>South Asians comprise one-quarter of the world's population, yet likely account for over 40% of global stroke deaths. They experience earlier stroke onset than whites, a 1.5-fold higher stroke mortality than Europeans, and a higher risk relative to other Asian populations. However, most studies aggregate South Asians with other Asian populations or compare native South Asians with other immigrant groups. This review synthesizes current evidence on the burden of stroke, epidemiology, risk factors, clinical presentation, subtypes, mechanisms, and treatment in South Asians, with an emphasis on disparities compared to other ethnic groups. We discuss risk factors including distinct cardiometabolic profiles, genetic polymorphisms that affect homocysteine levels and drug metabolism, dietary patterns, and lifestyle factors. We review stroke subtypes in South Asians and explore treatment and prevention strategies. Finally, we offer recommendations to target the multifactorial origins of elevated stroke burden in South Asians, including improvements in screening, pharmacogenomic testing, and thresholds for intracranial vessel imaging. To address this disparity and reduce the high burden of stroke in these communities, it is important to develop tailored management strategies, increase clinical trial representation, and establish South Asian stroke registries.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261463480"},"PeriodicalIF":6.9,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early versus late starting of direct oral anticoagulants after breakthrough ischemic stroke: A target trial analysis from the ASPERA-R study.","authors":"Lucio D'Anna, Matteo Foschi, Francesca Gabriele, Raffaele Ornello, Andrea Zini, Matteo Paolucci, Stefano Forlivesi, Mauro Gentile, Giacomo Urbinati, Angelo Cascio Rizzo, Maria Sessa, Ghil Schwarz, Rachele Tortorella, Gabriele Prandin, Soma Banerjee, Gaurav Desai, Leonardo Pantoni, Francesco Mele, Giuseppe Scopelliti, Ilaria Cova, Mariarosaria Valente, Domenico Maisano, Luca Antonelli, Maria Rosaria Bagnato, Giovanni Di Mauro, Francesca Bernocchi, Martina Gaia Di Donna, Barbara Casolla, Myriam Perla Mazloum, Kristina Kacani, Djeghlal Noufel-Anis, Laura González-Martin, Ricardo Rigual, Blanca Fuentes, Carlos Hervás, Paolo Candelaresi, Vincenzo Andreone, Antonio De Mase, Emanuele Spina, Diana Aguiar de Sousa, Mariana Almudi Souza, Alberto Fior, Miguel Serôdio, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Ahmed Abdelalim, Sandra Ahmed, Samah Ali Ismail, Liqun Zhang, Tara Latimer, Muhammad Elboghday, Ahmed ElBassiouny, Tamer Roushdy, Hossam Shokri, Federica Ferrari, Nicola Davide Loizzo, Federico Mazzacane, Maria Guarino, Valentina Barone, Paola Forti, Giuseppe Rinaldi, Marco Rossi, Vincenzo Laterza, Giovanni Frisullo, Pier Andrea Rizzo, Aldobrando Broccolini, Marina Mannino, Valeria Terruso, Marcella Caggiula, Simona Scalise, Ana Catarina Fonseca, Bernardo Antunes, Hrvoje Budincevic, Petra Crnac, Giovanna Viticchi, Mauro Silvestrini, Lorenzo Barba, Markus Otto, Viktoria Musienko, Piergiorgio Lochner, Benjamin Landau, Sandeep Buddha, Roumeisa Khalil, Maria Grazia Piscaglia, Ludovica Maria Miserocchi, Marialuisa Zedde, Ahmed Nasreldein, Luisa Vinciguerra, Luis Costa, Ahmed ElsaidElsayed, Mona Al Banna, Laura Tudisco, Maria Giulia Mosconi, Giovanni Merlino, Alexandros Polymeris, Federico De Santis, Simona Sacco","doi":"10.1177/17474930261463051","DOIUrl":"10.1177/17474930261463051","url":null,"abstract":"<p><strong>Background and purpose: </strong>Randomized trials support early initiation of direct oral anticoagulants (DOACs) after atrial fibrillation (AF)-related ischemic stroke, but patients with breakthrough ischemic stroke occurring despite ongoing anticoagulation have been largely under-represented. We evaluated the effectiveness and safety of early versus delayed DOAC initiation after breakthrough ischemic stroke.</p><p><strong>Methods: </strong>We performed a target trial emulation comparing early versus delayed DOAC initiation in patients with breakthrough ischemic stroke. Treatment strategies were prespecified using severity-adapted timing thresholds based on baseline National Institutes of Health Stroke Scale (NIHSS) scores. The study population was drawn from the retrospective arm of the international, multicenter Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulant (ASPERA) study and included patients with AF who experienced an ischemic stroke while receiving continuous anticoagulation. To emulate random assignment and avoid immortal time bias, a cloning-censoring-weighting approach with inverse probability weighting was applied. Primary outcomes were 90-day new ischemic events and moderate-to-severe bleeding. Risk ratios (RRs), absolute risk differences (RDs), and hazard ratios (HRs) were estimated using weighted regression and Cox models.</p><p><strong>Results: </strong>Among 833 patients (median age = 81 years), 336 were assigned to early and 497 to delayed DOAC initiation. At 90 days, early initiation was associated with a lower risk of new ischemic events (RR = 0.44, 95% CI = 0.21-0.90; RD = -3.64%, 95% CI = -6.40 to -0.87; HR = 0.43, 95% CI = 0.21-0.91). Moderate-to-severe bleeding occurred less frequently with early initiation (RR = 0.10, 95% CI = 0.01-0.76). Early initiation was also associated with lower 90-day all-cause and vascular mortality. A Net Early Benefit Score integrating ischemic and bleeding risks was positive across all NIHSS strata.</p><p><strong>Conclusion: </strong>In patients with breakthrough ischemic stroke, early severity-adapted DOAC initiation was associated with lower risks of recurrent ischemic events and mortality at 90 days without an increase in major bleeding. These findings support early anticoagulation initiation in this high-risk population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261463051"},"PeriodicalIF":6.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in pregnancy.","authors":"Valerie Arias, Ilayda Yilmaz Soylu, Eliza C Miller","doi":"10.1177/17474930261463866","DOIUrl":"10.1177/17474930261463866","url":null,"abstract":"<p><p>Maternal stroke, while rare, leads to significant maternal morbidity and mortality. Physiologic changes in pregnancy and the postpartum period disrupt cerebrovascular homeostasis, predisposing to pregnancy-specific syndromes and tripling stroke risk. Mechanisms of pregnancy-related stroke are diverse and include cardioembolism, vasculopathies (cervical artery dissections, reversible cerebral vasoconstriction syndrome), intracranial hemorrhage related to vascular lesions or preeclampsia, and cerebral venous thrombosis. Heterogeneity of presentation and limited experience treating pregnant women can contribute to challenges in diagnosis and management. This article reviews physiologic changes of pregnancy, as well as pregnancy-associated syndromes that predispose to stroke, including preeclampsia and other hypertensive disorders of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. We propose that hypertensive disorders of pregnancy and certain types of pregnancy-related stroke may share underlying mechanisms and represent a continuum of pregnancy-associated vasculopathy characterized by endothelial dysfunction and sympathetic hyperactivity. We also offer practical considerations for stroke clinicians, including safety of imaging modalities, therapeutic options both for prevention and treatment of pregnancy-related stroke, and prognosis after pregnancy-associated stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261463866"},"PeriodicalIF":6.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HERMES-24 score for outcome prediction in large vessel occlusion stroke: Real-world data from the Austrian stroke network.","authors":"Thomas Gattringer, Alexander Pichler, Dominika Mikšová, Simon Fandler-Höfler, Hannes Deutschmann, Markus Kneihsl, Astrid E Grams, Elke R Gizewski, Benjamin Dejakum, Stefan Kiechl, Jörg Weber, Luca De Paoli, Philipp Werner, Manfred Cejna, Peter Sommer, Rüdiger Schernthaner, Marek Sykora, Julia Ferrari, Christian Neumann, Christian Enzinger, Michael Knoflach","doi":"10.1177/17474930261463018","DOIUrl":"10.1177/17474930261463018","url":null,"abstract":"<p><strong>Background: </strong>The HERMES-24 score has recently been proposed to estimate the 90-day outcome in patients with anterior circulation large vessel occlusion (LVO) stroke.</p><p><strong>Aim: </strong>We aimed to further validate the HERMES-24 score in a real-world setting of LVO patients who had received endovascular stroke treatment (EVT).</p><p><strong>Methods: </strong>We used data of consecutive LVO patients treated with EVT in six Austrian stroke centers. The performance of the HERMES-24 score for outcome prediction at 90 days (modified Rankin Scale (mRS)) was investigated in predefined subgroups of anterior and vertebrobasilar LVO and within or beyond 6 h/unknown time windows.</p><p><strong>Results: </strong>We analyzed 1571 patients with available 90-day follow-up. The HERMES-24 score was predictive of 90-day mRS ⩽ 2 for the total cohort, those with anterior LVO <6 h, anterior LVO ⩾6 h/unknown, vertebrobasilar LVO < 6 h, and vertebrobasilar LVO ⩾ 6 h/unknown with c-statistics (95% confidence interval (CI)) 0.90 (0.88-0.92), 0.90 (0.88-0.92), 0.89 (0.86-0.92), 0.88 (0.79-0.98) and 0.98 (0.96-1.0), respectively. The HERMES-24 score also yielded excellent outcome prediction for 90-day mRS ⩽ 3, an ordinal mRS, and mortality in all subgroups (c-statistics: 0.83-0.99).</p><p><strong>Conclusion: </strong>The HERMES-24 score is highly predictive for 90-day outcome in real-world patients with LVO stroke treated with EVT regardless of LVO localization or symptom onset to treatment time.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261463018"},"PeriodicalIF":6.9,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive intra-arterial alteplase after near-complete or complete reperfusion in acute ischemic stroke: A post hoc analysis of the PEARL Trial.","authors":"Mingyi Bao, Chunnuan Chen, Haoyang Sun, Zhenhong Deng, Yanting Chen, Ruiqi Xue, Baixuan He, Xinguang Yang, Yi Li, Songhua Xiao, Yamei Tang, Yongteng Xu","doi":"10.1177/17474930261461367","DOIUrl":"10.1177/17474930261461367","url":null,"abstract":"<p><strong>Background: </strong>The benefit of adjunctive intra-arterial alteplase treatment following near-complete to complete reperfusion (expanded thrombolysis in cerebral infarction (eTICI) scale of 2c to 3) by mechanical thrombectomy for acute large vessel occlusion stroke remains controversial.</p><p><strong>Aims: </strong>The study aimed to explore whether intra-arterial alteplase was associated with improved outcomes in patients with eTICI 2c/3 after thrombectomy compared with standard treatment.</p><p><strong>Methods: </strong>This post hoc analysis used data from the PEARL (Intra-arterial Alteplase for Acute Ischemic Stroke After Mechanical Thrombectomy) randomized controlled trial conducted at 28 sites in China. Patients with anterior circulation large-vessel occlusion who achieved eTICI 2c/3 reperfusion after mechanical thrombectomy were included. Patients were randomized to intra-arterial alteplase or standard medical treatment. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 90 days. Safety outcomes included intracranial hemorrhage and symptomatic intracranial hemorrhage within 36 h and mortality at 90 days.</p><p><strong>Results: </strong>Of 324 randomized patients in the PEARL trial, 136 were included in this analysis, with 65 assigned to intra-arterial alteplase and 71 to standard medical treatment. Compared with standard medical treatment, intra-arterial alteplase was associated with a favorable shift in 90-day functional outcome (common odds ratio, 2.07 [95% confidence interval (CI), 1.10-3.92]; <i>P</i> = 0.02). Rates of intracranial hemorrhage (adjusted risk ratio, 1.06 [95% CI, 0.62-1.83]; <i>P</i> = 0.82), symptomatic intracranial hemorrhage within 36 h (adjusted risk ratio, 0.29 [95% CI, 0.03-2.82]; <i>P</i> = 0.29), and mortality at 90 days (adjusted hazard ratio, 0.97 [95% CI, 0.29-3.28]; <i>P</i> = 0.96) did not differ significantly between groups, although the number of safety events was low.</p><p><strong>Conclusion: </strong>Among patients in the PEARL trial who achieved near-complete to complete reperfusion after mechanical thrombectomy, adjunctive intra-arterial alteplase was associated with improved functional outcomes at 90 days. Owing to the small sample size of this study, a pooled analysis of intra-arterial alteplase in patients with eTICI 2c/3 is needed to confirm these results.</p><p><strong>Registration: </strong>Clinicaltrials.gov identifier: NCT05856851.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930261461367"},"PeriodicalIF":6.9,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenecteplase or alteplase for acute ischemic stroke beyond 4.5 hours of last known well: A pooled analysis of the TETRIS and EVATRISP registries.","authors":"Clémence Liegeois, Valerian Altersberger, Gaspard Gerschenfeld, Stéphane Olindo, Alexander Salerno, Mirjam R Heldner, Nicolas Martinez-Majander, Henrik Gensicke, Stefano Forlivesi, Gian Marco De Marchis, Nicolas Chausson, Petra Cimflova, Fernando Pico, Pierre Seners, Jiyoon Baik, Cristina Hobeanu, Tolga D Dittrich, Gaultier Marnat, Didier Smadja, Sami Curtze, Andrea Zini, Alexandra Maury, Davide Strambo, Sonia Alamowitch, Stefan T Engelter, Guillaume Turc","doi":"10.1177/17474930251385744","DOIUrl":"10.1177/17474930251385744","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis with tenecteplase within 4.5 h after ischemic stroke is noninferior to alteplase. However, it is uncertain whether this is also true in patients last known to be well more than 4.5 h before treatment initiation (last known to be well more than 4.5 h before treatment initiation (LKW > 4.5 h)). We aimed to compare tenecteplase and alteplase in this population using data from two large multicenter registries.</p><p><strong>Methods: </strong>Pooled retrospective analysis of acute stroke patients LKW > 4.5 h treated with tenecteplase 0.25 mg/kg (Tenecteplase Treatment in Ischemic Stroke Registry (TETRIS) registry) or alteplase 0.9 mg/kg (EVATRISP registry plus 4 French centers participating in TETRIS) based on the results of magnetic resonance imaging (MRI) or perfusion computed tomography (CT). Excellent functional outcome at 3 months (modified Rankin Scale (mRS) 0-1) was the primary outcome. Secondary outcomes were mRS 0-2, shift analysis of the mRS, any intracranial hemorrhage (ICH), symptomatic ICH, and death. Propensity-score overlap weighting (PSOW) was used to account for imbalance in baseline characteristics.</p><p><strong>Results: </strong>A total of 897 patients (tenecteplase: n = 419; alteplase: n = 478) were included between 2015 and 2024 (mean age: 74 (IQR 64-84); median National Institutes of Health Stroke Scale 11 (6-17) unknown stroke onset in 777 (86.6%) patients). At 3 months, mRS 0-1 was achieved in 138 (32.9%) and 178 (37.2%) patients treated with tenecteplase and alteplase, respectively (crude OR 0.83 (95% confidence interval (CI) 0.63-1.09); PSOW-OR 0.92 (95% CI 0.66-1.30)). Compared with alteplase, tenecteplase was not significantly associated with mRS 0-2 (PSOW-OR 0.78 (95% CI 0.56-1.08)) or better functional outcome over the whole range of the mRS (PSOW-common OR 0.83 (95% CI 0.62-1.11)). Tenecteplase was associated with significantly higher odds of any ICH (PSOW-OR: 1.79 (95% CI 1.25-2.57)), but not symptomatic intracranial hemorrhage (PSOW-OR 1.12 (95% CI 0.61-2.05)).</p><p><strong>Conclusions: </strong>The functional outcomes of patients LKW > 4.5 h treated with tenecteplase or alteplase did not significantly differ in this pooled analysis of two observational registries. However, the direction of the associations did not favor tenecteplase over alteplase, and therefore, more comparative studies-ideally randomized-are needed before routinely switching to tenecteplase in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"667-675"},"PeriodicalIF":8.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}