Journal of Investigative Medicine最新文献

{"title":"Efficacy and safety of Y-3 intracalvariosseous injection versus intravenous injection in the treatment of acute large hemispheric infarction (SOLUTION-2): rationale and design of a multicentre, prospective, randomised, open-label, blind endpoint (PROBE) trial.","authors":"Nanxing Wang, Meiyang Zhang, Mo Yang, Wenqian Liu, Weiming Liu, Yunwei Ou, Mengyuan Zhou, Xuan Wang, Zhiwei Sun, Yuesong Pan, Yongjun Wang, Yilong Wang","doi":"10.1136/svn-2024-004011","DOIUrl":"https://doi.org/10.1136/svn-2024-004011","url":null,"abstract":"<p><strong>Rationale: </strong>The blood-brain barrier (BBB) largely restricts the efficacy of neuroprotectants, which is an important approach in treating large hemispheric infarction (LHI). In this study, we harnessed intracalvariosseous (ICO) injection to bypass the BBB and facilitate drug delivery.</p><p><strong>Aim: </strong>To compare the efficacy and safety of ICO injection versus intravenous injection in the treatment of acute LHI within 24 hours of disease onset.</p><p><strong>Methods and design: </strong>The efficacy and safety of Y-3 ICO injection versus intravenous injection in the treatment of acute LHI (SOLUTION-2) is a multicentre, prospective, randomised, open-label, blind endpoint trial. 134 patients with acute LHI from more than six centres will be enrolled and randomised in the trial to receive ICO or intravenous injection of Y-3 in a 1:1 ratio.</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is the proportion of patients with a modified Rankin Scale score of 0-3 at 90 days after symptom onset. Primary safety outcomes include infection events related to ICO injection procedures.</p><p><strong>Discussion: </strong>Results from the SOLUTION-2 trial will contribute to the understanding of the efficacy and safety of the Y-3 ICO injection in patients with LHI.</p><p><strong>Trial registry: </strong>The efficacy and safety of Y-3 ICO injection versus intravenous injection in the treatment of acute LHI (SOLUTION-2). URL: https://clinicaltrials.gov/study/NCT06374667?cond=SOLUTION-2&intr=y-3&rank=1.</p><p><strong>Trial registration number: </strong>NCT06374667.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of accelerated biological ageing with incident dementia, cognitive functions and brain structure: a prospective cohort study based on UK Biobank.","authors":"Xiaowei Zheng, Wenyang Han, Yiqun Li, Minglan Jiang, Xiao Ren, Pinni Yang, Yiming Jia, Lulu Sun, Ruirui Wang, Mengyao Shi, Zhengbao Zhu, Yonghong Zhang","doi":"10.1136/svn-2024-003690","DOIUrl":"https://doi.org/10.1136/svn-2024-003690","url":null,"abstract":"<p><strong>Background: </strong>Several small-sample studies have suggested that biological processes of ageing are implicated with dementia and cognitive function. We aimed to prospectively investigate the associations of biological age with incident dementia, cognitive functions and brain structure based on the UK Biobank.</p><p><strong>Methods: </strong>A total of 287 846 participants without dementia at baseline (followed until November 2022) were analysed. We measured biological age from clinical traits using the Klemera-Doubal method Biological Age (KDM-BA) and PhenoAge algorithms. Cox models were applied to evaluate the risk of dementia. Logistic regression models and linear regression models were used to assess the association between cognitive functions and brain structural measures.</p><p><strong>Results: </strong>During a median follow-up of 13.68 years, 4744 incident all-cause dementia (ACD) events (including 3013 Alzheimer's disease (AD) and 853 vascular dementia (VaD)) were recorded. Participants with older biological age were at increased risk of incident dementia (HR=1.35, 95% CI 1.23 to 1.48 for KDM-BA acceleration, 1.71 (1.52 to 1.91) for PhenoAge acceleration). Those with the highest level of KDM-BA and PhenoAge acceleration had the highest risk of ACD risk, with the corresponding HR of 1.80 (95% CI 1.60 to 2.03) and 1.19 (1.09 to 1.29), respectively. The associations between biological ageing with AD and VaD were also significant. Furthermore, a higher level of biological age was associated with worse performance in multiple cognitive domains and brain structural measures.</p><p><strong>Conclusion: </strong>A higher level of biological age may represent a potential risk factor for incident dementia and is associated with worse performance in multiple cognitive domains and brain structural measures.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular β-amyloid potentially colocalises with phosphorylated tau in cerebral amyloid angiopathy.","authors":"Hsin-Hsi Tsai, Bo-Ching Lee, Chia-Ju Liu, Pu-Tien Chiang, Ya-Chin Tsai, Li-Kai Tsai, Syu-Jyun Peng","doi":"10.1136/svn-2024-003774","DOIUrl":"https://doi.org/10.1136/svn-2024-003774","url":null,"abstract":"<p><strong>Background: </strong>Tau pathology is observed in cerebral amyloid angiopathy (CAA) and is related to cognitive impairment and neurodegeneration. However, the relationship between tau pathology and amyloid accumulation in the vasculature is unknown. We aimed to assess if regional associations exist between vascular amyloid and tau protein in sporadic CAA.</p><p><strong>Method: </strong>We assessed cerebral amyloid and hyperphosphorylated tau in patients with probable CAA or Alzheimer's disease (AD) using ¹¹C-Pittsburgh compound B (PiB) and ¹⁸F-T807 positron emission tomography (PET). PET data for each region of interest were extracted using an automated anatomical labelling atlas. We generated correlation matrices to investigate the regional correlations between PiB and T807 uptake, which were further adjusted for multiple comparisons. We evaluated if the severity of regional cortical superficial siderosis (cSS) mediates these associations.</p><p><strong>Results: </strong>67 patients with CAA (38 with intracerebral haemorrhage and 29 with cognitive impairment) and 21 patients with AD were included. Significant correlations between amyloid and tau PET uptake were observed in regions of interest for the temporal, parietal and occipital lobes in CAA (adjusted p<0.05); these correlations were not observed in AD. In CAA, the severity of regional cSS correlated positively with T807 uptake in the temporal (β=0.108, 95% CI 0.030 to 0.186, p=0.007) and occipital lobes (β=0.088, 95% CI 0.008 to 0.168, p=0.032). Regional cSS showed no mediating effect on the association between PiB and T807 in the occipital and temporal lobes.</p><p><strong>Conclusions: </strong>In CAA, tau pathology exhibits significant regional in situ correlations with amyloid deposition in the posterior brain, which suggests a distinct pathophysiology to AD.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroacupuncture reduces neuroinflammation and neuronal pyroptosis via downregulating Neat1 in rats after stroke.","authors":"Wanqing Lin, Zhaolian Cai, Xiaoyong Zhong, Xiaofang You, Renyu Yu, Bin Chen","doi":"10.1136/svn-2024-003964","DOIUrl":"https://doi.org/10.1136/svn-2024-003964","url":null,"abstract":"<p><strong>Background: </strong>We investigated the potential contribution of the lncRNA Neat1 to the therapeutic efficacy of electroacupuncture (EA) after ischaemic stroke.</p><p><strong>Methods: </strong>EA stimulation was used to treat cerebral ischaemia/reperfusion injury (CIRI) in the rat model. Post-therapeutic intervention, infarct volume (IV), brain water content and neurological impairments were assessed. Furthermore, TUNEL and immunofluorescence staining were performed to examine cellular apoptosis, neuronal loss and neuroglial activation. Additionally, Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR), western blotting, ELISA and electron microscopy were employed to assess the NLRC4 inflammasome pathway and neuronal pyroptosis in rats subjected to CIRI.</p><p><strong>Results: </strong>Present findings confirmed that EA successfully downregulated Neat1 and IV in response to CIRI. Moreover, the positive impacts of EA on neurobehavioural recovery, suppression of brain damage and reduction in MAP2 degradation were reversed by Neat1 overexpression. Neat1 overexpression also blocked the reduction in NLRC4 activation, including that of components such as NLRC4, Caspase-1 and gasdermin D, as well as the decrease in cellular apoptosis and neuronal pyroptosis induced by EA. Furthermore, Neat1 overexpression counteracted the suppressive effects of EA on proinflammatory microglial polarisation (Iba1⁺/CD11b⁺) and increased neurogenesis (Nestin⁺/Sox2⁺) in EA-treated rats. Finally, Neat1 overexpression inhibited the ability of EA to lower proinflammatory factors and elevated anti-inflammatory cytokines in the ischaemic striatum.</p><p><strong>Conclusions: </strong>These results highlight a novel anti-inflammatory mechanism of EA that involves the lncRNA Neat1/NLRC4 pathway, which regulates the inhibition of neuronal pyroptosis and neuroinflammation. This mechanism may work as an attainable therapeutic objective for EA-induced neuroprotection against ischaemic stroke.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of histone deacetylases and sirtuins in the ischaemic stroke: a systematic review and meta-analysis of animal studies.","authors":"Ali Majdi, Shahin Yaraghi, Ali Moharrami, Amirreza Ghaffari Tabrizi, Morteza Dojahani, Erfan Alirezapour, Kamyar Mansori, Mehdi Eskandari, Hossein Mostafavi","doi":"10.1136/svn-2025-004159","DOIUrl":"https://doi.org/10.1136/svn-2025-004159","url":null,"abstract":"<p><strong>Background: </strong>Treatment of ischaemic stroke requires exploration of novel neuroprotective strategies owing to the constraints of thrombolytic therapy. Recent research implies that modulation of histone deacetylases (HDAC) or sirtuins (SIRT) could be beneficial in achieving this goal.</p><p><strong>Methods: </strong>This systematic review and meta-analysis evaluates the effectiveness of HDAC/SIRT enzyme modulation in treating acute ischaemic stroke. It includes relevant studies but excludes human and in vitro research and non-primary studies. An electronic search was conducted across databases PubMed, Web of Science and Scopus until 20 March 2025. The methodological quality was assessed using a modified SYRCLE risk of bias tool. Infarct volume and neurological responses were extracted as key outcomes, and a random-effects meta-analysis of infarct volume was conducted for studies directly targeting HDAC/SIRT enzymes.</p><p><strong>Results: </strong>A review of 71 studies involving over 1600 animals focused on ischaemic stroke treatments, predominantly using male rodents in a transient middle cerebral artery occlusion model. Most treatments were administered intraperitoneally, starting from the inception of ischaemia until 5 days afterwards. Non-selective HDAC inhibitors and SIRT1 modulators were targeted most frequently. The meta-analysis on infarct volume with 95% CI showed an overall effect estimate of -1.529 and suggested that non-selective HDAC inhibitors exhibit the most promise in reducing infarct size. Additionally, agonists of SIRT3/7, SIRT6, SIRT1 and HDAC1, along with inhibitors of SIRT5, HDAC6 and HDAC3, may play a significant role in the treatment of ischaemic stroke. Importantly, neuroprotective treatments have been found to be most effective in reducing infarct volume when administered within 24 hours following ischaemia.</p><p><strong>Discussion: </strong>This study highlights the most promising neuroprotective trials for ischaemic stroke by focusing on infarct volume as a key outcome. However, relying exclusively on infarct volume may not fully capture the effectiveness of these treatments.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombolytic agents, more options, more challenges.","authors":"Yi Dong, Lu Xu, Lan Hong, Ye Liu, Wenjun Tu, Huaguang Zheng, Xinyi Leng, Yunyun Xiong, Xin Cheng, David Z Wang","doi":"10.1136/svn-2025-004072","DOIUrl":"https://doi.org/10.1136/svn-2025-004072","url":null,"abstract":"","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the effectiveness and safety of rescue balloon angioplasty versus stenting in acute large vessel occlusion after thrombectomy.","authors":"Yu Jiang, Chao Li, Mingchao Shi, Kangjia Song, Menglu Cong, Wenbin Zhang, Lanqi Li, Shouchun Wang","doi":"10.1136/svn-2024-003851","DOIUrl":"https://doi.org/10.1136/svn-2024-003851","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic stenosis (ICAS) is a leading cause of failed mechanical thrombectomy (MT). To achieve successful recanalisation, rescue strategies such as balloon angioplasty and stenting are frequently employed. In this study, we aimed to investigate the comparative efficacy and safety of these strategies.</p><p><strong>Methods: </strong>We retrospectively analysed the data of 321 patients with ICAS-related large vessel occlusion (LVO) treated with rescue balloon angioplasty (n=212) or stenting (n=109) after MT. The primary outcome was favourable outcomes (modified Rankin Scale score of 0-2) at 3 months. Multivariate logistic regression identified predictors of outcomes, including subgroup analyses for anterior and posterior circulation.</p><p><strong>Results: </strong>Overall, data of 321 patients (median age, 60 (IQR, 53-67) years; 80.4% male) were analysed from an initial cohort of 1601 patients. At 3 months, the balloon group demonstrated a trend towards a higher rate of favourable outcomes (34.9% vs 45.8%; OR 0.62, 95% CI 0.36 to 1.09, p=0.098). The stent group showed a trend towards a higher incidence of symptomatic intracranial haemorrhage (11.0% vs 4.2%; OR 2.22, 95% CI 0.80 to 6.14, p=0.124). In the posterior circulation subgroup, favourable outcomes were significantly lower in the stent group (20.5% vs 41.5%; OR 0.32, 95% CI 0.10 to 0.98, p=0.047).</p><p><strong>Conclusion: </strong>Balloon angioplasty after MT may improve clinical outcomes to some extent in ICAS-related LVO with a lower incidence of intracranial haemorrhage compared with stenting, while stenting is an effective measure to prevent long-term restenosis.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting clinical outcome in posterior circulation large-vessel occlusion patients with endovascular recanalisation: the GNC score.","authors":"Jia-Qi Wang, Si-Qi Qiu, Wei Li, Jing Qiu, Thanh Nguyen, Hui-Sheng Chen","doi":"10.1136/svn-2025-004131","DOIUrl":"https://doi.org/10.1136/svn-2025-004131","url":null,"abstract":"<p><strong>Background and purpose: </strong>Acute ischaemic strokes caused by posterior circulation large-vessel occlusions (pc-LVOs) are associated with particularly poor prognoses, including significant disability and mortality rates. This study sought to develop and validate a novel scoring system for predicting functional outcomes in pc-LVO cases following successful endovascular recanalisation.</p><p><strong>Methods: </strong>We derived a predictive model from the DETECT-China cohort and externally validated it using the DETECT2-China dataset. Poor outcome was defined as a modified Rankin Scale score of 4-6 at 90 days. Cerebral circulation time (CCT), measured via digital subtraction angiography (DSA), served as a key predictor. Multivariable logistic regression was employed to construct the scoring system.</p><p><strong>Results: </strong>The training cohort comprised 92 patients, of whom 52 (56.5%) experienced poor outcomes. Multivariate analysis identified prolonged CCT (adjusted OR (aOR) 1.365; 95% CI 1.105 to 1.686; p=0.004), elevated admission National Institutes of Health Stroke Scale (NIHSS) (aOR 1.235; 95% CI 1.120 to 1.363; p<0.001) and higher blood glucose levels (aOR 1.345; 95% CI 1.023 to 1.769; p=0.034) as independent predictors. These variables were integrated into the GNC score (Glucose-NIHSS-CCT). The GNC score demonstrated excellent predictive performance for clinical outcome, good discrimination and calibration in this cohort, as well as the bootstrap validation. Importantly, the excellent performance of this score was further validated in DETECT2-China.</p><p><strong>Conclusions: </strong>This is the first report that CCT based on DSA is an independent prognostic marker in pc-LVO patients with successful recanalisation post-endovascular treatment. The GNC score, incorporating readily available clinical and angiographic parameters, offers a reliable tool for outcome prediction in this high-risk population.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of contrast staining following mechanical thrombectomy in acute ischaemic stroke.","authors":"Jing Yan, Xiang Xu, Haiyan Li, Zhonghua Yang, Ximing Nie, Na Wei, Dandan Yu, Hongyi Yan, Miao Wen, Ling Wang, Liping Liu","doi":"10.1136/svn-2025-004113","DOIUrl":"https://doi.org/10.1136/svn-2025-004113","url":null,"abstract":"<p><strong>Background: </strong>Advances in endovascular thrombectomy (EVT) and extended treatment criteria have improved outcomes in acute ischaemic stroke (AIS). However, contrast staining (CS) on postoperative CT complicates clinical decision-making and outcome evaluation. We investigated the association between postoperative CS and 90-day clinical outcomes in AIS patients.</p><p><strong>Methods: </strong>In this multicentre observational study, we enrolled AIS patients treated with EVT who underwent non-contrast CT (NCCT) within 2 hours postprocedure. Patients were stratified into two groups based on the presence or absence of CS to further explore the relationship between CS characteristics and clinical outcomes. The primary outcome was poor functional outcome, defined as a modified Rankin Scale score ≥3 at 90 days, evaluated with the logistic regression analysis adjusted for age, sex and other clinical features.</p><p><strong>Results: </strong>Among the 420 patients (mean age 63 years; 74.3% male), CS was observed in 250 (59.5%) following EVT. Logistic regression analysis showed that CS was strongly associated with poor functional outcomes. At 3 months, the proportion of patients with functional dependence was significantly higher in the CS group (76.8%) compared with the non-CS group (62.4%). In addition, the CS group exhibited a higher death rate compared with the non-CS group (p=0.028). Our study found that CS in the pons, as well as larger and denser staining volumes, was often indicative of poor prognosis.</p><p><strong>Conclusion: </strong>In around half of AIS patients with EVT, CS can be observed and independently associate with poor clinical outcomes, primarily related to the location and density of CS.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of intravenous recombinant plasminogen activator treatment in Chinese patients with acute ischaemic stroke aged over 80 years: a retrospective cohort study.","authors":"Jiansheng Yang, Yu-Hui Huang, Wansi Zhong, Xiaoxian Gong, Yi Chen, Zhicai Chen, Haidi Jin, Shenqiang Yan, Liyan Huang, Chang-Zheng Yuan, Min Lou","doi":"10.1136/svn-2024-004004","DOIUrl":"https://doi.org/10.1136/svn-2024-004004","url":null,"abstract":"<p><strong>Background: </strong>Risks and benefits of intravenous recombinant tissue plasminogen activator (rt-PA) remain unclear among elderly patients with acute ischaemic stroke (AIS). This study investigated 1-year clinical outcomes of intravenous rt-PA treatment in Chinese patients aged >80 years with AIS.</p><p><strong>Methods: </strong>This retrospective multicentre study included patients with AIS aged >80 years from the Computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation stroke registry platform between January 2017 and March 2020 who arrived at the hospital within 4.5 hours of symptom onset. Patients who received intravenous rt-PA were propensity score-matched (1:1) by baseline characteristics with those who did not receive reperfusion therapy. The primary outcome was modified Rankin scale (mRS) score 0-1 at 1 year; secondary outcomes were any intracranial haemorrhage (ICH) and all-cause mortality during hospitalisation, mRS 0-2, mRS score distribution and all-cause mortality at 1 year.</p><p><strong>Results: </strong>The analysis included 1560 propensity score-matched elderly patients (intravenous rt-PA, n=780; non-reperfusion, n=780). At 1 year, the intravenous rt-PA group had a higher proportion of patients with mRS 0-1 (27.7% vs 23.8%; OR 1.87, 95% CI 1.35 to 2.59, p<0.001), mRS 0-2 (37.3% vs 33.7%; OR 2.02, 95% CI 1.48 to 2.75, p<i><</i>0.001) and an overall shift towards better outcomes than placebo (mRS mean±SD score: 3.5±2.4 vs 3.7±2.3; OR 0.77, 95% CI 0.64 to 0.93, p=0.007). No significant differences were observed in any ICH and all-cause mortality during hospitalisation and at 1 year.</p><p><strong>Conclusions: </strong>This study provided real-world evidence for a positive benefit-risk profile of intravenous rt-PA in Chinese patients with AIS aged >80 years.</p><p><strong>Trial registration number: </strong>NCT05401149.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}