Stroke

IntroductionFor more than two decades, the standard for thrombolysis for Acute Ischemic Stroke (AIS) has been alteplase 0.9 mg/kg (maximum 90 mg) with 10 % given as a bolus. More recent studies such as the EXTEND-IA, and AcT study have shown tenecteplase (TNK) may have potential advantages over alteplase for AIS. In November 2024 the ATTEST-2 study was published with the largest comparative prospective study to date. This study included 1858 patients from 39 stroke centers in the UK which were r...

Background and PurposeAs populations age, there is an increasing need to optimize endovascular treatment (EVT) for acute ischemic stroke. We harmonized prospective stroke registries from Korea and Taiwan to enable direct comparisons of patient characteristics and clinical outcomes, with a particular focus on the impact of advanced age. MethodsProspective stroke registries in South Korea (CRCS-K) and Taiwan (TREAT-AIS) were harmonized to form a unified dataset of patients treated with EVT. EVT o...

BackgroundDual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended within 24 hours for patients with minor ischemic stroke or high-risk transient ischemic attack (TIA). However, the optimal timing for initiating DAPT in real-world practice remains unclear. MethodsWe conducted a secondary analysis of the Clinical Research Center for Stroke-Korea National Institute of Health (CRCS-K-NIH) registry, a prospective multicenter cohort involving 20 stroke centers across South Korea ...

Background and PurposePatients with large vessel occlusion (LVO) stroke of milder baseline clinical severity are often missed by pre-hospital severity-based triage tools. We examined whether these patients had differences in 1) markers of collateral circulation and 2) the relative harm of transfer delays on outcome, compared to patients with clinically more severe baseline deficits. MethodsRegistry data from two large Australian thrombectomy centers was used to identify all directly presenting ...

BackgroundThe purpose of this study was to report the safety and performance of aspiration thrombectomy for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment. MethodsThis is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated with aspiration thrombectomy with the Pen...

BackgroundWhile endovascular thrombectomy (EVT) is considered as the most effective treatment for a select group of patients with acute ischemic stroke and large vessel occlusion, its safety and efficacy in older patients are still debated especially in "read-world" settings. This study reports outcomes of EVT in acute ischemic stroke patients aged 90 and older in our community hospital setting. MethodsData between January 2018 and December 2022 were aggregated for all acute ischemic stroke pat...

BackgroundMechanical thrombectomy has become standard-of-care in the treatment of emergent large vessel occlusion. However, it is not yet known if social factors impact post-thrombectomy recovery. We studied the association between clinical and sociodemographic factors with 3-month functional outcomes post thrombectomy. MethodsIn this prospective cohort study, 291 patients who underwent mechanical thrombectomy at Montefiore-Einstein Hospital in NYC between 1/1/2021 and 4/1/2024 were analyzed. T...

BackgroundEndovascular thrombectomy (EVT) has revolutionized acute ischemic stroke management but remains inaccessible to many patients due to anatomical, clinical, or logistical barriers. Treatment strategies for patients with intracranial occlusions who are ineligible for intravenous thrombolysis remain undefined. We evaluated the safety of short-term "Triple Therapy" (TT; heparin, aspirin, clopidogrel) in this population. MethodsWe conducted a retrospective analysis of patients aged 18-90 wi...

IntroductionEndovascular thrombectomy (EVT) has revolutionized the treatment of patients with large vessel occlusion (LVO) stroke. Three-month functional independence ranges between 33 and 60%, and mortality between 12 and 25%. Few studies have presented outcomes beyond five years and their reported odds or hazard ratios are difficult to apply clinically. Median survival is also challenging to interpret correctly. Restricted mean survival time (RMST) is a clinically intuitive metric that gives s...

BackgroundThe elevated head position may lower intracranial pressure but has been associated with an increased risk of early neurological deterioration before endovascular therapy (EVT). However, among patients with medium-to-large infarct cores who achieve successful reperfusion after EVT, the efficacy and safety of elevated head positioning remain uncertain. ObjectiveThis study aims to evaluate whether maintaining patients in an elevated head position (30{degrees}-40{degrees}) versus a flat l...

BackgroundMechanical thrombectomy (MT) has significantly improved outcomes in acute ischemic stroke (AIS) due to large vessel occlusions (LVOs) up to 24 hours post-onset. The effectiveness of MT for medium vessel occlusions (MeVOs) in the M2 or M3 segments of the middle cerebral artery beyond 6 hours is less investigated. MethodsThis retrospective study analyzed 80 patients who underwent MT for primary, isolated M2 or M3 segment occlusions between January 2020 and August 2023. Patients were cat...

BackgroundRecent randomized trials have questioned the benefit of endovascular therapy (EVT) for medium vessel occlusion (MeVO) stroke, but data from clinical practice are limited. This study aimed to assess the effectiveness and safety of EVT, with or without intravenous thrombolysis (IVT), versus IVT alone in MeVO stroke using registry-based real-world data. MethodsThis retrospective multicenter study included patients from 82 Italian centers in the SITS registry (January 2020-December 2023)....

BackgroundMechanical thrombectomy (MT) is established as standard care for acute ischemic stroke (AIS) due to large vessel occlusion, but its role in distal medium vessel occlusions (DMVOs) remains uncertain. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of MT vs best medical management (BMM) in patients with DMVO-related AIS. MethodsA systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted through February 2025 to identify ra...

Background and purposeGuidelines recommend patients with high-risk TIAs and minor stroke presenting within 1-3 days from onset be offered dual antiplatelet therapy (DAPT). There is little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective Database. MethodsThe Qatar Stroke Database began enrollment of patients with TIAs and acute stroke in 2014 and currently has [~] 16,000 patients. For this study we eva...

BackgroundEndovascular thrombectomy (EVT) is standard treatment for an acute ischemic stroke due to large-vessel occlusions (AIS-LVO) with a small ischemic core, but the effect of EVT on AIS-LVO with a large ischemic core remains unclear. The objective was to assess the benefit and safety of EVT for AIS-LVO with large ischemic cores. Methods and FindingPubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from January 1 2000 to September 25 2025. Rando...

BackgroundEndovascular stroke treatment (EST) has become the treatment of choice for middle cerebral artery (MCA) M1-segment occlusions. Little is known about the implications for revascularization success of occlusions with persisting antegrade perfusion before initiation of treatment (modified Treatment In Cerebral Ischemia (mTICI 1)) compared to a complete occlusion (mTICI 0). Here, we compared the impact of these two states of target vessel occlusion on recanalization success and clinical ou...

IntroductionFast delivery of intravenous thrombolysis (IVT) and transportation to a comprehensive stroke center (CSC) is paramount in primary stroke centers (PSCs), to achieve effective reperfusion. We investigated clinical outcomes and workflow times of patients treated with IVT at PSCs. MethodologyThis is a secondary analysis of the AcT trial, a multicenter, phase-3, randomized, controlled, noninferiority trial comparing tenecteplase with alteplase in patients with acute ischemic stroke withi...

ImportanceDouble stentretriever (double-SR) is used as a rescue technique when recanalization is not achieved in stroke patients undergoing thrombectomy. Double-SR, if applied as first-line technique could increase first-pass recanalization rates, known to be associated with better outcomes. ObjectiveTo assess the safety and efficacy of first-line double-SR in stroke patients undergoing thrombectomy. DesignRandomized, controlled, blinded adjudicated primary outcome study between 2022 and 2023....

BackgroundTwo RCTs demonstrated efficacy and safety of IV alteplase for patients with acute ischemic stroke (AIS) who awaken with symptoms or with last known well (LKW) more than 4.5 hours prior to arrival. However, real world experience using CT perfusion (CTP) or DWI-MRI for patient selection in the U.S. is limited. We developed the Tufts Late Presenter Thrombolysis (LPT) protocol to offer alteplase to patients with wakeup stroke, known LKW more than 4.5 hours, or unknown LKW likely more than ...

BackgroundAmong patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) who undergo successful reperfusion following endovascular thrombectomy (EVT), only one-third are disability-free at 90 days, which may be related to persistent microvascular hypoperfusion after thrombectomy known as the "no-reflow phenomenon". Adenosine is administered to prevent percutaneous coronary intervention (PCI)-related no-reflow through microvasculature dilation and neutrophil-mediated in...