Journal of Stroke最新文献

{"title":"Intracranial Vessel Morphology in <I>RNF213</I>-Related Vasculopathy: A Quantitative Imaging Study in Ischemic Stroke Patients.","authors":"I Joon Han, Hyung Jun Kim, Hyun Kyung Kim, Ha-Na Song, Seong-Hoon Lee, Yun-Hwa Ha, In-Young Baek, Ji-Eun Lee, Seongvin Ju, Jong-Won Chung, Gyeong-Moon Kim, Oh Young Bang, Woo-Keun Seo","doi":"10.5853/jos.2025.06282","DOIUrl":"10.5853/jos.2025.06282","url":null,"abstract":"<p><strong>Background and purpose: </strong>The RNF213 p.R4810K variant is a major susceptibility allele for moyamoya disease (MMD) in East Asians. This study investigated the relationship between RNF213 variants and intracranial vessel morphology in acute ischemic stroke.</p><p><strong>Methods: </strong>Patients from the Samsung Medical Center (SMC) Stroke Registry (2017-2019) were included. Quantitative vessel features were extracted from magnetic resonance angiography, including the basal global tortuosity index (GTIb), internal carotid artery (ICA) area, and basal minimum-to-maximum diameter ratio (MMRb). Genome-wide association analyses of GTIb, ICA area, and MMRb were performed (n=945). Validation was conducted in an independent Korea University Medical Center (KUMC) cohort. Groupwise comparisons were performed across three predefined groups: MMD+/variant+, MMD-/variant+, and MMD-/variant-. Adjusted linear regressions for ICA area were performed. Receiver operating characteristic (ROC) analyses evaluated GTIb, ICA area, and a combined model for identifying RNF213 carriers.</p><p><strong>Results: </strong>GTIb and ICA area showed genome-wide significance at the RNF213 locus (p.R4810K), whereas MMRb did not. In the KUMC cohort, ICA area differed between variant+ and variant-groups, while GTIb and MMRb did not. Across SMC groups (MMD+/variant+ [n=14], MMD-/variant+ [n=37], MMD-/variant- [n=888]), GTIb was highest and ICA area and MMRb smallest in MMD+/variant+, intermediate in MMD-/variant+, and lowest/largest in MMD-/variant- (P<0.001). ICA area differences remained significant after multivariable adjustment. In ROC analyses, ICA area provided significant incremental discrimination beyond clinical variables.</p><p><strong>Conclusions: </strong>The RNF213 variant was consistently associated with smaller ICA area in patients with ischemic stroke. The association with intracranial tortuosity was not reproduced in the validation cohort.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"393-404"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenecteplase for Acute Ischemic Stroke: From Molecular Bioengineering to Phase III Pivotal Trials.","authors":"Jae Wook Jung, Jin Soo Lee","doi":"10.5853/jos.2026.03412","DOIUrl":"10.5853/jos.2026.03412","url":null,"abstract":"<p><p>Intravenous thrombolysis with alteplase is a primary reperfusion therapy for acute ischemic stroke, yet its clinical utility is constrained by a short half-life, continuous infusion requirements, and susceptibility to plasminogen activator inhibitor-1. Tenecteplase, a bioengineered variant of alteplase, was developed to address these limitations through a prolonged half-life, increased fibrin specificity, and enhanced resistance to plasminogen activator inhibitor-1. These structural modifications enable single-bolus administration and reduce systemic fibrinolytic disturbance. In this review, we examine how the targeted molecular modifications of tenecteplase shaped its stepwise translational development in acute ischemic stroke. We first detail the limitations of alteplase, which motivated the transition to alternative agents, the molecular rationale for tenecteplase, and its preclinical evidence. Furthermore, we synthesize the phase II dose-finding trials that established 0.25 mg/kg as providing the optimal efficacy and safety balance, distinguishing it from the excess intracranial hemorrhage observed with the 0.4 mg/kg dose. Finally, we review the pivotal phase III trials across diverse populations demonstrating that tenecteplase 0.25 mg/kg is non-inferior to alteplase and represents a practical, evidence-based alternative, particularly where single-bolus administration may facilitate workflow or transfer for endovascular thrombectomy. Viewed through this molecular-to-clinical framework, the development of tenecteplase illustrates how targeted protein engineering can translate into pharmacological, operational, and clinical advantages in stroke reperfusion therapy.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 3","pages":"357-371"},"PeriodicalIF":11.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Low-Density Lipoprotein Cholesterol Levels on Atherosclerotic Vascular Changes: Analysis of Korean Treat Stroke to Target Trial.","authors":"Sang Hee Ha, Jae-Chan Ryu, Sung Hee Ahn, Jae-Kwan Cha, Sang Min Sung, Tae-Jin Song, Kyung Bok Lee, Eung-Gyu Kim, Yong-Won Kim, Ji Hoe Heo, Man Seok Park, Kyusik Kang, Byung-Chul Lee, Keun-Sik Hong, Oh Young Bang, Jei Kim, Jong S Kim","doi":"10.5853/jos.2025.05652","DOIUrl":"10.5853/jos.2025.05652","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"330-333"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Surgery Status and the Risks of Ischemic Stroke and Safety Outcomes With Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation: A Nationwide Population-Based Cohort Study.","authors":"Jiyeon Ha, Wookjin Yang, Mi-Sook Kim, Eung-Joon Lee, Matthew Chung, Boyeon Yang, Hyemin Jang, Jeong-Min Kim, Keun-Hwa Jung, Seung-Hoon Lee","doi":"10.5853/jos.2025.05295","DOIUrl":"10.5853/jos.2025.05295","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although gastrointestinal (GI) surgery can affect drug efficacy, its impact on oral anticoagulants (OACs) remains unclear. This study investigated the impact of GI surgery on the comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation (AF).</p><p><strong>Methods: </strong>Using a nationwide South Korean claims database, AF patients prescribed OACs between 2015 and 2021 were analyzed. The primary outcome was ischemic stroke, and secondary outcomes were major bleeding, all-cause death, and composite outcome (ischemic stroke, major bleeding, all-cause death). Outcomes were compared by OAC type (DOAC vs. warfarin) and GI surgery status using inverse probability of treatment weighting and a Fine-Gray subdistribution hazard model with time-varying covariates.</p><p><strong>Results: </strong>Among 388,214 AF patients (mean age, 71.9 yr; 42.7% male), 6,907 (1.8%) underwent GI surgery. The effect of GI surgery differed between warfarin and DOACs for ischemic stroke (Pint= 0.018), with increased risk for warfarin (adjusted HR [aHR]: 2.32; 95% confidence interval [CI] 1.17-4.62), but not for DOACs (aHR: 0.97 [95% CI 0.77-1.22]) after surgery. Effects of surgery on major bleeding, all-cause death, and composite outcome did not differ. In post-GI surgery setting, DOACs demonstrated lower ischemic stroke risk (aHR: 0.35 [95% CI 0.17-0.72]) and comparable risks for other outcomes. Exploratory analyses by surgery location suggested a more favorable profile of DOACs after upper GI surgery.</p><p><strong>Conclusions: </strong>In AF patients, GI surgery significantly increased ischemic stroke risk among warfarin users, but not among DOAC users. DOACs showed generally favorable profiles after GI surgery and may remain a reasonable anticoagulant, with potentially more favorable profile after upper GI surgery.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":"228-239"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different Long-Term Outcomes According to Thrombus Histology in Patients With Acute Ischemic Stroke.","authors":"Hyungwoo Lee, JoonNyung Heo, Jae Wook Jung, Hyo Suk Nam, Ji Hoe Heo, Minyoul Baik, Joonsang Yoo, Jinkwon Kim, Tae-Jin Song, Gyu Sik Kim, Kwon-Duk Seo, Tae Dong Ok, Jin Kyo Choi, Il Kwon, Young Dae Kim","doi":"10.5853/jos.2025.03412","DOIUrl":"10.5853/jos.2025.03412","url":null,"abstract":"<p><strong>Background and purpose: </strong>The relationship between thrombus histology and long-term stroke patient outcomes remains unexplored. We aimed to determine whether the histological characteristics of thrombi are associated with long-term outcomes in stroke patients and to identify the thrombus features linked to these outcomes.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included 512 patients with ischemic stroke who underwent endovascular thrombectomy between July 2017 and July 2023. Patients were followed up for long-term major adverse cardiovascular events occurrence. Thrombus histology was assessed using immunohistochemistry, including the proportion of fibrin, red blood cells, and platelets, as well as the distribution patterns categorized as layered, erythrocytic, diffuse platelet, and mixed.</p><p><strong>Results: </strong>During a median follow-up of 38.1 months, 164 patients experienced major adverse cardiovascular events, with an incidence rate of 3.02 per 100 person-years. Major adverse cardiovascular events occurrence was associated with the diffuse platelet pattern and proportion of platelets and red blood cells within the thrombus. After adjusting for confounders, the diffuse platelet pattern independently predicted major adverse cardiovascular events, including mortality and stroke recurrence. Subgroup analysis also demonstrated that the association between the diffuse platelet pattern and major adverse cardiovascular events was consistent across key clinical subgroups based on age (≥65 vs. <65 yr), atrial fibrillation, cancer status, and discharge medications.</p><p><strong>Conclusions: </strong>Thrombus histology could provide predictive value for long-term prognosis. In particular, histological distribution patterns may be more important than simple composition in thrombus research, including in the prediction of prognosis.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"263-272"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Endovascular Thrombectomy in Isolated Cervical Internal Carotid Artery Occlusion While on Oral Anticoagulation.","authors":"Lukas Mayer-Suess, Christoph Riegler, João Pedro Marto, Pimrapat Gebert, Tilman Reiff, Marek Sykora, Marcin Wiącek, David Pakizer, André Araújo, Adrien Ter Schiphorst, João André Sousa, Arno Reich, Belen Flores Pina, Cristina Hobeanu, Marialuisa Zedde, João Nuno Ramos, Georgios Tsivgoulis, Pedro Castro, Sven Poli, José Nuno Alves, Anne Dusart, Blanca Fuentes, Herbert Tejada Meza, Jelle Demeestere, Susanne Wegener, Lars Kellert, Patricia Calleja, Cristina Panea, Christoph Vollmuth, Karl Georg Haeusler, Liliana Pereira, Ronen Leker, Timo Uphaus, Andrea Zini, Henrik Gensicke, Gauthier Duloquin, Taraneh Ebrahimi, Alexander Salerno, Cristina Tiu, Thanh N Nguyen, Sebastian García-Madrona, Marta Bilik, Shadi Yaghi, Halina Sienkiewicz-Jarosz, Michał Karliński, Stefan Krebs, Eva Hurtíková, Nathalia Ferreira, João Sargento-Freitas, João Pinho, Isabel Rodriguez Caamaño, Elke Ruth Gizewski, Pierre Seners, Rosario Pascarella, Klearchos Psychogios, Alexandra Gómez-Expósito, Sara Gomes, Flavio Bellante, Jorge Rodríguez-Pardo, Mario Bautista Lacambra, Robin Lemmens, Corinne Inauen, Johannes Wischmann, Fernando Ostos, Vlad Tiu, Miguel Rodrigues, Issa Metanis, Marianne Hahn, Maria Maddalena Viola, Simon Truessel, Yannick Béjot, Louisa Nitsch, Davide Strambo, Elena Oana Terecoasa, Mohamad Abdalkader, Alicia De Felipe, Farhan Khan, Caroline Arquizan, Manuel Ribeiro, Martin Roubec, Izabella Tomaszewska-Lampart, Julia Ferrari, Peter Ringleb, Christian H Nolte","doi":"10.5853/jos.2025.05918","DOIUrl":"10.5853/jos.2025.05918","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"321-325"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Thrombectomy Dilemma in Stroke Patients With Active Cancer: To Treat or Not to Treat?","authors":"Yohanna Kusuma, Mikiya Beppu, Beom Joon Kim, Sung-Chun Tang, Mikito Hayakawa, Hiroshi Yamagami, Hiroyuki Kawano, Teruyuki Hirano, Shinichi Yoshimura, Hamidon Basri, Richard Li, Huy Thang Nguyen, Deidre Anne De Silva, Keun-Sik Hong, Jiann-Shing Jeng, Than G Phan, Henry Ma, Bernard Yan","doi":"10.5853/jos.2026.00262","DOIUrl":"10.5853/jos.2026.00262","url":null,"abstract":"<p><p>Endovascular thrombectomy for acute large-vessel occlusion in patients with active cancer remains a difficult clinical decision. Multiple cohort studies and meta-analyses indicate that, when standard imaging and clinical criteria are applied, reperfusion success is high and symptomatic intracranial hemorrhage is broadly comparable with non-cancer populations, arguing against categorical exclusion. At the same time, registries show lower 90-day functional independence and higher 90-day mortality in active-cancer cohorts-effects likely driven by malignancy-related systemic factors and pre-existing functional compromise rather than procedural harm. This narrative review synthesizes efficacy and safety signals, highlights decision-grade outcomes that are seldom reported-early neurological change, performance status around 90 days, and whether systemic anticancer therapy is started or resumed. It sets out a clinical-ethical-economic framework to support selection, consent, and aftercare, including a pragmatic pathway for under-resourced settings based on non-contrast computed tomography (CT) or single-phase CT angiography where advanced perfusion imaging or magnetic resonance imaging are unavailable. We outline an Asia-Pacific collaborative program designed to identify subgroups that may benefit from reperfusion and initiation of active cancer care.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"218-227"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Oral Anticoagulant and Antiplatelet for Atrial Fibrillation and Cerebral Atherosclerosis: A Meta-Analysis.","authors":"Hyungwoo Lee, JoonNyung Heo, Jae Wook Jung, Hyo Suk Nam, Young Dae Kim","doi":"10.5853/jos.2025.04609","DOIUrl":"10.5853/jos.2025.04609","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with ischemic stroke with both atrial fibrillation (AF) and large artery atherosclerosis (LAA) represent therapeutic challenges, and the optimal antithrombotic regimen remains uncertain. We conducted a meta-analysis comparing oral anticoagulant (OAC) monotherapy with OAC plus antiplatelet therapy in this population.</p><p><strong>Methods: </strong>PubMed and EMBASE were searched through June 30, 2025, for studies enrolling patients with ischemic stroke and evidence of both AF and LAA. Outcomes included recurrent ischemic stroke, major bleeding, all-cause mortality, and a composite outcome. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Peto method, with random-effects sensitivity analyses, stratified by short-term (<3 months) and long-term (≥1 year) follow-up.</p><p><strong>Results: </strong>Eight cohort studies were analyzed. In the short-term, combination therapy was associated with a reduced risk of recurrent ischemic stroke (OR, 0.37; 95% CI, 0.14-0.97; P=0.043), without a significant increase in major bleeding, although this association did not persist under random-effects sensitivity analysis (OR, 0.37; 95% CI, 0.13-1.07; P=0.067). Conversely, long-term combination therapy was associated with higher risks of major bleeding (OR, 1.25; 95% CI, 1.08-1.45; P=0.002), all-cause mortality (OR, 1.25; 95% CI, 1.01-1.54; P=0.039), and composite outcome (OR, 1.49; 95% CI, 1.27-1.74; P<0.001), without reducing recurrent ischemic stroke (OR, 1.12; 95% CI, 1.00-1.26; P=0.054).</p><p><strong>Conclusions: </strong>While long-term OAC plus antiplatelet therapy increases bleeding risk without preventing recurrent stroke, short-term combination therapy may offer benefits in selected patients with concomitant LAA, though this early efficacy signal should be interpreted with caution.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"303-311"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating Stroke Risk in Type 2 Diabetes Through Physical Activity: A Nationwide Population-Based Study in Sweden.","authors":"Anastasios Mavridis, Björn Eliasson, Dongni Buvarp, Adam Viktorisson","doi":"10.5853/jos.2025.05113","DOIUrl":"10.5853/jos.2025.05113","url":null,"abstract":"<p><strong>Background and purpose: </strong>Type 2 diabetes (T2DM) is associated with elevated stroke risk. Physical activity may attenuate this excess risk, but large-scale population evidence is limited. This study evaluated whether physical activity mitigates excess stroke risk in individuals with T2DM compared with age- and sex-matched individuals without diabetes.</p><p><strong>Methods: </strong>All adults with T2DM registered in the Swedish National Diabetes Register between 2010 and 2019 were included and matched 1:3 to individuals without diabetes based on age and sex. Participants were stratified into five groups according to physical activity. Stroke incidence was estimated using Kaplan-Meier curves, and Cox proportional hazards models calculated adjusted hazard ratios (HRs) for ischemic and hemorrhagic stroke. Robustness was assessed using competing risks regression.</p><p><strong>Results: </strong>The cohort included 369,704 individuals with T2DM (mean [standard deviation] age, 64.3 [12.3] years; 156,729 female individuals [42.4%]) and 1,109,112 matched individuals without diabetes. The adjusted HR for ischemic stroke in inactive individuals with T2DM compared with individuals without diabetes was 1.36 (95% confidence interval [CI] 1.23-1.50), declining with higher activity and becoming non-significant among those active ≥3 times/week (HR 1.05, 95% CI 0.96-1.15). The elevated ischemic stroke risk at higher glycated hemoglobin levels was attenuated in individuals with higher physical activity.</p><p><strong>Conclusions: </strong>Higher physical activity levels were associated with reduced stroke risk in individuals with T2DM. Those active at least three times weekly had stroke risk comparable to individuals without diabetes of the same age and sex. Promoting physical activity should be an integral component of diabetes care and stroke prevention.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"240-249"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombus Migration After Tenecteplase Versus Alteplase in Acute Large Vessel Occlusion.","authors":"Lu Wang, Fuxia Yang, Xiao Wu, Lulan Li, Xueqiao Jiao, Fangfang Zhang, Fengyuan Che, Hongxing Han, Weidong Liu, Peifu Wang, Xuesong Li, Junfeng Shi, Jia Liu, Xunming Ji, Xiuhai Guo","doi":"10.5853/jos.2025.05386","DOIUrl":"10.5853/jos.2025.05386","url":null,"abstract":"<p><strong>Background and purpose: </strong>In patients with large vessel occlusion (LVO), intravenous thrombolysis (IVT) frequently alters thrombus location; however, the clinical impact of this phenomenon remains unclear. We aimed to compare post-IVT thrombus dynamics between tenecteplase and alteplase and to evaluate the association between thrombus dynamics and 3-month outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed prospectively collected, multicenter data from consecutive patients with LVO who underwent bridging therapy between January 2022 and December 2024. Thrombus dynamics were classified as resolution, migration, or stability. Analyses incorporated propensity score matching with weighting to balance baseline characteristics.</p><p><strong>Results: </strong>Of the 806 initially included patients, 746 were included after matching (373 treated with tenecteplase and 373 treated with alteplase). The incidence of thrombus migration was significantly higher in the tenecteplase group than in the alteplase group (19.3% vs. 11.3%; odds ratio [OR]: 1.92; 95% confidence interval [CI] 1.27-2.91). The advantage of tenecteplase over alteplase was restricted to patients with an IVT-to-puncture time of <60 minutes (18.6% vs. 6.2%; P=0.001) and was no longer significant when the interval ≥60 minutes (19.7% vs. 15.0%; P=0.204; Pinteraction=0.043). Additionally, thrombus migration was associated with a better functional outcome (OR: 1.62; 95% CI 1.04-2.53). Finally, tenecteplase was associated with improved functional independence compared with alteplase (OR: 1.43; 95% CI 1.04-1.95).</p><p><strong>Conclusions: </strong>Tenecteplase demonstrated superior efficacy in inducing thrombus migration compared with alteplase, particularly within 60 minutes of IVT administration. Thrombus migration independently predicted improved functional independence. These findings support the preferential use of tenecteplase for bridging therapy in patients with LVO.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"28 2","pages":"283-292"},"PeriodicalIF":11.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}