Journal of Investigative Medicine最新文献

{"title":"Adjunct tirofiban treatment after successful endovascular thrombectomy recanalisation in acute anterior circulation ischaemic stroke (ATTRACTION): protocol of a multicentre, prospective, double-blinded, randomised trial.","authors":"Xiang Luo, Hao Huang, Sha-Bei Xu, Guo Li, Yi Zhang, Yiming Luo, Qianqian Kong, Yi Xie, Chen-Chen Liu, Gang Deng, Yi-Hui Wang, Dong-Hui Ao, Lingning Lan, Ying Yu, Zhouping Tang, Wei Wang","doi":"10.1136/svn-2025-004638","DOIUrl":"https://doi.org/10.1136/svn-2025-004638","url":null,"abstract":"<p><strong>Background: </strong>Successful recanalisation without functional independence is a frequent phenomenon following endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke.</p><p><strong>Aim: </strong>To demonstrate the safety and efficacy of adjunct tirofiban therapy after EVT in patients with anterior circulation LVO stroke achieving successful recanalisation, defined as modified Thrombolysis In Cerebral Infarction 2b-3.</p><p><strong>Design: </strong>The study of adjunct tirofiban treatment after successful EVT recanalisation (ATTRACTION: Adjunct Tirofiban Treatment after Successful Endovascular Thrombectomy Recanalisation in Acute Anterior Circulation Ischaemic Stroke) is a multicentre, prospective, double-blinded, randomised trial enrolling 1360 patients in China. Eligible patients will be randomised 1:1 to either the tirofiban or placebo group.</p><p><strong>Outcome: </strong>The primary efficacy outcome is assessed as the proportion of participants with a modified Rankin Scale score of 0-2 at 90 days, and the primary safety outcome is symptomatic intracranial haemorrhage within 48 hours from randomisation.</p><p><strong>Conclusions: </strong>This study will provide evidence on the efficacy and safety of sequential tirofiban therapy after successful recanalisation in patients with anterior circulation LVO stroke.</p><p><strong>Trial registration number: </strong>NCT06265051.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700341","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":"White matter hyperintensities and 90-day outcomes in patients with mild ischaemic stroke or high-risk TIA.","authors":"Min Cheng, Hang Li, Ying Gao, Hongyi Yan, Xinru Liu, Yingying Yang, Weiqi Chen, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1136/svn-2025-004529","DOIUrl":"https://doi.org/10.1136/svn-2025-004529","url":null,"abstract":"<p><strong>Background: </strong>Patients with large-artery atherosclerotic ischaemic stroke or high-risk transient ischaemic attack (TIA) often exhibit varying degrees of white matter hyperintensities (WMH), but the impact of WMH on the risk of stroke recurrence remains uncertain. We explored whether the burden of WMH increases the risk of bleeding and affects the efficacy of antiplatelet therapies in individuals experiencing mild ischaemic stroke or high-risk TIA.</p><p><strong>Methods: </strong>This was a post hoc analysis of the intensive statin and antiplatelet therapy for high-risk intracranial or extracranial atherosclerosis trial, which was a double-blind, placebo-controlled, 2×2 factorial, and randomised clinical trial conducted at 222 centres in China. Patients were randomised to receive clopidogrel with aspirin or placebo. We rated WMH on baseline brain MRI Fazekas scores: mild WMH (Fazekas grade 0-2), moderate WMH (Fazekas grade 3-4) and severe WMH (Fazekas grade 5-6). The primary efficacy and safety outcomes were new stroke and moderate-to-severe bleeding within 90 days.</p><p><strong>Results: </strong>We included 5454 patients (mean age: 64.0 years (SD, 9.5); 36.3% female), including 2681 with mild WMH, 1829 with moderate WMH and 944 with severe WMH. At 90 days, the rate of moderate-to-severe bleeding in patients with severe WMH was 1.6% (adjusted HR (aHR), 3.46 (95% CI 1.50 to 8.02)), compared with 0.5% in those with mild WMH (p=0.004). Haemorrhagic stroke occurred in 1% of patients with severe WMH (aHR, 5.95 (95% CI 1.72 to 20.62), p=0.005). However, we found no significant association with new stroke, and no interactions were observed between WMH severity and antiplatelet therapy.</p><p><strong>Conclusions: </strong>Severe WMH was associated with haemorrhagic stroke and bleeding events in patients with acute mild ischaemic stroke or high-risk TIA, with low absolute event rates and imprecise effect estimates; no evidence of interaction with antiplatelet therapy was observed.</p><p><strong>Trial registration number: </strong>NCT03635749.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700354","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":"Endovascular treatment for symptomatic intracranial artery stenosis: current strategies and future challenges.","authors":"Xu Guo, Fan Zhang, Jia-Lin Liu, Li-Feng Wang, David Wang, Zhongrong Miao","doi":"10.1136/svn-2025-004419","DOIUrl":"https://doi.org/10.1136/svn-2025-004419","url":null,"abstract":"<p><p>Over the past two decades, substantial progress has been made in the endovascular treatment of symptomatic intracranial atherosclerotic stenosis (sICAS). In this study, we performed a comprehensive review focusing on patient selection criteria, advanced imaging modalities for lesion characterisation, evolving endovascular therapeutic approaches, the innovation of next-generation neurointerventional devices, and the evidence-based recommendations outlined in clinical guidelines and expert consensus statements for the treatment of sICAS.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693102","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":"Impact of epileptic seizures on functional outcome after subdural haematoma: a systematic review and meta-analysis.","authors":"Alexandru Guranda, Knarik Isoyan, Florian Wilhelmy, Tim Wende, Felix Arlt, Erdem Güresir, Johannes Wach, Martin Vychopen","doi":"10.1136/svn-2025-005038","DOIUrl":"https://doi.org/10.1136/svn-2025-005038","url":null,"abstract":"<p><strong>Objective: </strong>Epileptic seizures (ES) are a frequent and clinically relevant complication in patients with subdural haematoma (SDH), yet their influence on short-term outcome remains uncertain. This meta-analysis aimed to quantify the association between ES and functional outcome after acute (aSDH) and chronic SDH (cSDH).</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and registered in PROSPERO. PubMed, MEDLINE and the Cochrane Library were searched through June 2024. Eligible studies included adult patients with aSDH or cSDH reporting ES or status epilepticus in relation to functional outcome or mortality. Pooled risk ratios (RR) with 95% CIs were calculated using random-effects models. Heterogeneity (I²), sensitivity, influence and publication-bias analyses were performed.</p><p><strong>Results: </strong>Twelve studies met inclusion criteria, including seven on aSDH, three on cSDH (n=1512) and two on population-based cohorts (>1.6 million patients). In aSDH, ES were significantly associated with poor outcome (RR=1.38, 95% CI 1.10 to 1.73; p<0.001; I^²=83%), whereas in cSDH, only a non-significant trend was observed (RR=1.79, 95% CI 0.79 to 4.09; I^² = 93%). Population-level data showed nearly doubled mortality among seizure-positive cases (RR=1.92, 95% CI 1.76 to 2.08; I^² = 30%). Sensitivity and influence analyses confirmed robustness, with no publication bias.</p><p><strong>Conclusions: </strong>Seizures are associated with poorer outcomes in aSDH; evidence in cSDH remains limited. These findings emphasise the need for standardised seizure management and prospective studies to clarify causal links between seizures and recovery.</p><p><strong>Prospero registration number: </strong>CRD42024583608.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693092","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":"Efficacy and safety of edaravone sublingual tablet for patients with cerebral small vessel disease-related cognitive impairment: study protocol for a multicentre, randomised, double-blind, placebo-controlled trial.","authors":"Qing Ye, Weidong Ling, Haifeng Chen, Yue Cheng, Lili Huang, Yuting Mo, Xin Zhang, Linjie Yu, Hailan Meng, Lai Qian, Rong Rong, Xiaolei Zhu, Yun Xu","doi":"10.1136/svn-2025-004198","DOIUrl":"10.1136/svn-2025-004198","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel disease (CSVD) represents a leading aetiology of vascular cognitive impairment, yet effective treatments for CSVD-related cognitive impairment (CSVD-CI) are limited. Although edaravone has shown potential in alleviating CSVD's pathophysiological changes, its efficacy in CSVD-CI remains underexplored, partly due to the lack of a suitable long-term dosage form.</p><p><strong>Aim: </strong>This trial aims to assess the efficacy and safety of edaravone sublingual tablets (EST) for cognitive impairment in patients with CSVD.</p><p><strong>Methods and design: </strong>This multicentre, randomised, double-blind, placebo-controlled trial will enrol patients with CSVD-CI, randomly assigning them to receive either EST or placebo for 24 weeks of treatment with concurrent follow-up, followed by an additional 24-week post-treatment follow-up period. Cognitive function, safety, MRI-based CSVD burden, cerebral arterial endothelial function and immune-mediated inflammation will be assessed. The primary outcome is the between-group difference in Montreal Cognitive Assessment score changes from baseline to week 48, along with adverse event incidence. Secondary outcomes include changes in cognitive domain scores, CSVD burden, deep regional cerebral perfusion and levels of glial fibrillar acidic protein (GFAP), neurofilament light chain and inflammatory factors in peripheral blood from baseline to weeks 24 and 48.</p><p><strong>Discussion: </strong>This trial will evaluate the efficacy and safety of EST in patients with CSVD-CI, potentially offering a new treatment strategy for this condition.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436774","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":"Lesion network mapping navigated continuous theta burst stimulation for motor recovery in acute ischaemic stroke (MASTRE): rationale and design of a randomised double-blind controlled multicentre phase 2 trial.","authors":"Lingling Ding, Hao Liu, Wei Liu, Luo Yi, Yijun Zhou, Yingzhuo Zang, Jing Jing, Xiping Gong, Qian Jia, Yongjun Wang, Tao Liu, Zixiao Li","doi":"10.1136/svn-2025-004641","DOIUrl":"https://doi.org/10.1136/svn-2025-004641","url":null,"abstract":"<p><strong>Background: </strong>In stroke recovery, the heterogeneity of lesions and symptoms makes it challenging to target neuromodulation precisely. Conventional one-size-fits-all neuromodulation approaches yield inconsistent outcomes, highlighting the need for precision strategies, such as lesion network mapping (LNM), to identify patient-specific symptom-related networks.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of LNM-guided continuous theta-burst stimulation (cTBS) in improving motor recovery in patients with acute ischaemic stroke (AIS) treated within 14 days of symptom onset.</p><p><strong>Design: </strong>The mapping navigated continuous theta-burst stimulation for motor recovery (MASTRE) trial is a multicentre, randomised, double-blind, sham-controlled Phase 2 study. Eligible participants will be randomly assigned (1:1) to receive either active LNM-guided cTBS or sham stimulation. For each participant, individualised stimulation targets will be determined through LNM, and real-time neuronavigation will be used to ensure precise modulation of the disrupted sensorimotor network. Treatment will consist of one daily session for seven consecutive days. In each session, cTBS will be delivered as bursts of three pulses at 50 Hz, repeated every 200 ms for 40 s.</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is the change in Fugl-Meyer Assessment total motor score from baseline to Day 7 post-randomisation. Safety assessments will include symptomatic intracranial haemorrhage and adverse events, which will be monitored through Day 90 post-randomisation.</p><p><strong>Discussion: </strong>The MASTRE study introduces an innovative approach to optimise cTBS therapy in AIS patients by employing LNM to identify patient-specific targets within affected sensorimotor networks. Results from this trial may inform a new precision neurorehabilitation framework, promoting personalised therapeutic interventions tailored to individual neural connectivity profiles.</p><p><strong>Trial registration number: </strong>NCT06400407.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677949","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":"Endovascular treatment for MILD ischaemic stroke with acute anterior circulation large vessel occlusion: a multicentre, prospective, randomised, clinical trial (MILD-MT) protocol.","authors":"Meihua Wu, Tingyu Yi, Pengfei Xing, Yan-Min Wu, Ding-Lai Lin, Xiaohui Lin, Ming-Zhu Huang, Zeguang Ren, Jianmin Liu, Pengfei Yang, Tuanyuan Zheng, Meng Zhang, Hao Wang, Wenhuo Chen","doi":"10.1136/svn-2025-004832","DOIUrl":"https://doi.org/10.1136/svn-2025-004832","url":null,"abstract":"<p><strong>Background: </strong>Acute ischaemic stroke (AIS) with a National Institutes of Health Stroke Scale (NIHSS) score <6 is termed as mild stroke. The benefit of endovascular therapy (EVT) for patients with mild stroke caused by large vessel occlusion (LVO) is uncertain.</p><p><strong>Aim and design: </strong>MILD-MT trial is a multicentre, prospective, randomised, open-label, blinded endpoint (PROBE) trial designed to evaluate whether EVT combined with best medical management (EVT+BMM) is superior to BMM alone in patients with mild stroke due to anterior circulation LVO. Eligible patients have confirmed intracranial carotid artery (ICA), middle cerebral artery (MCA M1/M2) segment with or without ipsilateral extracranial ICA occlusion, symptom onset within 24 hours, small core infarct (≤50 mL), and substantial perfusion mismatch (≥50 mL), a profile indicating high risk for early neurological deterioration.</p><p><strong>Sample size: </strong>Aim to randomise 300 patients 1:1 to receive EVT+BMM (intervention) or BMM alone (control).</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is the proportion of excellent functional outcomes (defined as modified Rankin Scale 0 or 1 score) at 90±7 days. The primary safety outcomes include symptomatic intracranial haemorrhage within 48 hours according to the Heidelberg criteria; END is defined as an increase in NIHSS score ≥4 or ≥2 in any individual item within 7 days after randomisation and all-cause mortality at 90±7 days.</p><p><strong>Discussion: </strong>The MILD-MT trial could result in substantial evidence regarding the efficacy and safety of EVT for mild patients with AIS-LVO and large salvageable volume within 24 hours from symptom onset.</p><p><strong>Trial registration number: </strong>(NCT06179017).</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677884","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":"Extending the time window for intravenous tenecteplase in patients with distal medium vessel occlusions stroke: study protocol and rationale.","authors":"Xiaozhong Jing, Raul G Nogueira, Thanh Nguyen, Mohamad Abdalkader, Abdullah M Al-Qudah, Chunrong Tao, Rui Li, Jun Sun, Yuyou Zhu, Li Wang, Zhang Chao, Tianlong Liu, Jianlong Song, Jeffrey L Saver, Wei Hu","doi":"10.1136/svn-2025-004727","DOIUrl":"https://doi.org/10.1136/svn-2025-004727","url":null,"abstract":"<p><strong>Background: </strong>The TRACE III trial showed that for patients with large arterial occlusion presenting 4.5-24 hours of symptom occurrence and a salvageable penumbra on perfusion imaging, intravenous tenecteplase (TNK) thrombolysis is safe and can significantly improve patient outcomes in cases where endovascular thrombectomy is not feasible. However, it is currently unknown whether intravenous TNK thrombolysis beyond 4.5 hours can improve the outcomes of subjects with distal medium vessel occlusion (MeVO).</p><p><strong>Objective: </strong>To determine the safety and effectiveness of extended window TNK thrombolysis for MeVO stroke.</p><p><strong>Methods and design: </strong>Extending the Time Window for Intravenous TNK in Patients with Distal Medium Vessel Occlusions Stroke (TNK-MeVO) is a prospective, randomised, controlled, multicentre and open-label study with blinded outcome assessment. Up to 560 eligible subjects will be randomised 1:1 to receive TNK thrombolysis or standard medical management in over 40 comprehensive stroke centres across China.</p><p><strong>Outcomes: </strong>The primary endpoint is the rates of modified Rankin Scale score of 0-1 at 90 days. Safety endpoints include symptomatic intracerebral haemorrhage within 24 hours and mortality at 90 days.</p><p><strong>Conclusions: </strong>TNK-MeVO trial is designed to provide robust evidence on whether TNK thrombolysis is safe and effective for acute MeVO stroke presenting 4.5-24 hours of symptom onset.</p><p><strong>Trial registration number: </strong>NCT06559436.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677917","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":"Frequent flyers: recurrent large vessel occlusion requiring thrombectomy.","authors":"Mikiya Beppu, Yohanna Kusuma, Peter J Mitchell, Richard Dowling, Steven Bush, Cameron Williams, Conor Houlihan, Shinichi Yoshimura, Bernard Yan","doi":"10.1136/svn-2025-005036","DOIUrl":"https://doi.org/10.1136/svn-2025-005036","url":null,"abstract":"<p><strong>Background: </strong>Repeat thrombectomy for recurrent large vessel occlusion (LVO) is uncommon but clinically consequential. Although previous studies have described general causes of recurrent LVO, the association between recurrence timing and underlying aetiology-particularly atrial fibrillation-remains poorly characterised.</p><p><strong>Methods: </strong>We performed a retrospective study of consecutive patients who underwent repeat thrombectomy for recurrent LVO at a tertiary comprehensive stroke centre between January 2020 and December 2024. Recurrence timing was stratified into early (≤1 day) versus delayed (≥2 days). Clinical characteristics, aetiology and procedural variables were compared between early versus delayed group.</p><p><strong>Results: </strong>Among 1116 thrombectomy procedures, 16 patients (1.4%) had recurrent LVO requiring thrombectomy. Eight patients (50.0%) had early recurrence, and eight (50.0%) had delayed recurrence. Early events demonstrated a consistent same-vessel pattern (8/8, 100%) and were exclusively associated with non-atrial fibrillation mechanisms, including intracranial atherosclerotic disease and arterial dissection. In contrast, delayed recurrence was strongly associated with atrial fibrillation (7/8, 87.5%; p<0.001). Notably, four of seven atrial fibrillation-related cases (57.1%) were not on appropriate anticoagulation at the time of recurrence. Functional outcomes at 90 days did not differ significantly between groups (median modified Rankin Scale 5 vs 5; p=0.704).</p><p><strong>Conclusions: </strong>Recurrent LVO after thrombectomy appeared to display distinct time-dependent patterns in this cohort. These findings suggest that recurrence timing may serve as a practical clinical marker to guide targeted evaluation-vascular imaging and plaque assessment for early recurrence cases, and intensified rhythm monitoring for delayed cases. Larger studies are needed to validate these time-specific patterns.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634302","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":"Intravenous tenecteplase before endovascular thrombectomy in patients with acute basilar artery occlusion within 4.5-24 hours: study protocol and rationale.","authors":"Rui Li, Thanh Nguyen, Chunrong Tao, Jun Sun, Pengfei Xu, Cong Luo, Li Wang, Tianlong Liu, Jianlong Song, Xiaozhong Jing, Anmo Wang, Adnan I Qureshi, Mohamad Abdalkader, Jeffrey L Saver, Raul G Nogueira, Wei Hu","doi":"10.1136/svn-2025-004275","DOIUrl":"https://doi.org/10.1136/svn-2025-004275","url":null,"abstract":"<p><strong>Background and purpose: </strong>One clinical trial demonstrated the beneficial effect of intravenous tenecteplase for large vessel occlusion patients not undergoing endovascular thrombectomy (EVT) within 4.5-24 hours. However, for those with acute basilar artery occlusion (BAO) presenting beyond the 4.5-hour therapeutic window, it remains unknown whether intravenous thrombolysis before EVT is beneficial. This study hypothesised that treatment of acute BAO patients with intravenous tenecteplase before EVT will result in better clinical outcomes vs EVT alone within 4.5-24 hours.</p><p><strong>Methods and design: </strong>ATTENTION LATE is a prospective, multicentre, randomised, controlled, open-label trial with blinded endpoint assessment. This study will enrol patients with acute BAO who present within 4.5-24 hours of symptom onset. These patients will be randomised 1:1 to either intravenous tenecteplase bridging to EVT or EVT alone.</p><p><strong>Study outcomes: </strong>A score of 0-2 on the modified Rankin Scale at 90 days will serve as the primary endpoint.</p><p><strong>Discussion: </strong>The ATTENTION LATE trial evaluates whether administering intravenous tenecteplase is safe and effective for acute BAO patients prior to EVT beyond the 4.5-hour time frame. This trial could establish the basis for expanding the eligible patient population to receive intravenous thrombolysis and extending the time window for acute BAO.</p><p><strong>Trial registration number: </strong>NCT05701956.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634454","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}