Incidence, Associations, and Mechanisms of Unexplained Early Neurologic Deterioration After Thrombectomy in Stroke Patients.

Background And Objectives: Early neurologic deterioration (END) in ischemic stroke after endovascular thrombectomy (EVT) is a frequent complication that remains unexplained in most cases. We aimed to explore the incidence of, and associated variables with, unexplained END (unEND).

Methods: This is a post hoc analysis of the ESCAPE-NA1 trial, a double-blind, multicentric, randomized clinical trial evaluating nerinetide vs placebo in adult ischemic stroke patients with anterior circulation large vessel occlusion treated with EVT.

Faster Thrombolysis Is Associated With Improved Cognitive Outcomes in Patients With Acute Ischemic Stroke Treated With Alteplase and Tenecteplase: A Substudy of the AcT Trial.

Background: Cognitive impairment after stroke is linked with poorer functional outcomes. Faster thrombolytic improves recanalization, 3-month functional recovery, and in-hospital survival. We examined whether faster treatment times from door-to-needle and symptom onset-to-needle (OTN) impacted cognition.

Left-Sided Neurological Symptoms and Negative Diffusion-Weighted MRI in Suspected Minor Stroke Patients.

Background: Historically, it has been proposed that functional neurological symptoms occur more frequently on the left side of the body due to a distinct body representation and emotional processing of the right hemisphere, yet objective imaging data to support this are lacking. We aimed to investigate whether patients with acute left-sided symptoms (right hemisphere) suspected of having a minor stroke are more likely to show negative diffusion-weighted imaging (DWI) compared to those with right-sided symptoms.

Methods: Data are from the SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment) multicenter prospective cohort study conducted between 2013 and 2017.

Safety and Real-World Effectiveness in the Transition from Alteplase to Tenecteplase for Stroke Treatment.

Background: Tenecteplase has been shown to be non-inferior to alteplase for the treatment of acute ischemic stroke within 4.5 hours of stroke onset. While not formally approved by regulatory authorities, many jurisdictions have transitioned to using tenecteplase for routine stroke treatment because it is simpler to use and has cost advantages.

COSMOS: Interrater and Intrarater Reliability Study of a Novel Outcome Measure.

The vast majority of patients with minor stroke achieve what are considered good or excellent outcomes on the modified Rankin Scale (0-1/0-2), yet many are dissatisfied with their outcomes. There is a need for a functional outcome measure tailored for minor stroke that better reflects the spectrum of clinical outcomes within this population. We developed the Canadian Outcome Scale for Minor Stroke (COSMOS) and performed an interrater and intrarater reliability study.

The Effect of Training and Certification for the NIHSS and the mRS on Rater Performance: A Systematic Review.

Background: Up-to-date certification of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) is often required for clinical trials, representing a significant burden on clinical investigators globally.

Aims: This systematic review sought to determine if NIHSS or mRS training, re-training, certification or recertification led to improvements in the reliability or accuracy of ratings as well as other relevant user metrics (e.g.

Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration.

Background: Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.

Sex Differences in Outcomes After Tenecteplase for Minor Stroke: A Subanalysis of the TEMPO-2 Trial.

Background: In this subanalysis of the TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischaemic Stroke With Proven Occlusion) trial, a randomized clinical trial comparing tenecteplase and nonthrombolytic control in patients with minor stroke and symptomatic intracranial occlusion, we investigated sex differences in the efficacy and safety of tenecteplase.

Methods: We compared outcomes after tenecteplase versus control, stratified by sex. We also compared outcomes in female versus male patients treated with tenecteplase.

Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis.

Importance: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke is not well-known.

Objective: To determine the annual incidence rates and cumulative incidences of stroke up to 10 years after TIA or minor stroke.

Data Sources: MEDLINE, Embase, and Web of Science were searched from inception through June 26, 2024.

Safety, Functional Disability, Healthcare Utilization, and Quality-of-Life Outcomes in Elderly Receiving Alteplase and Tenecteplase: A Secondary Analysis From the AcT Trial.

Background: Older age has been associated with overall poorer outcomes in acute ischemic stroke. We compared (1) outcomes in various health-related domains among patients <80 years and ≥80 years presenting with acute ischemic stroke and (2) whether outcomes differ between intravenous TNK (tenecteplase) versus alteplase.

Methods: Data are from patients included in AcT (Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke), a pragmatic, registry-linked, phase 3 randomized controlled trial comparing TNK with alteplase.

Feasibility of telephone and computerized cognitive testing as a secondary outcome in an acute stroke clinical trial: A mixed methods sub-study of the AcT Trial.

Introduction: Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently.

Patients And Methods: Prospective cognitive outcomes were collected at 90-180 days using both telephone MoCA (T-MoCA; range 0-22; <17 impairment) and Creyos, a computerized cognitive battery.

Factors Influencing Nerinetide Effect on Clinical Outcome in Patients Without Alteplase Treatment in the ESCAPE-NA1 Trial.

Background And Purpose: In the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial, treatment with nerinetide was associated with improved outcomes in patients who did not receive intravenous alteplase. We compared the effect of nerinetide on clinical outcomes in patients without concurrent intravenous alteplase treatment within different patient subgroups.

Methods: ESCAPE-NA1 was a multicenter randomized trial in which acute stroke patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) >4 undergoing endovascular treatment (EVT) were randomized to intravenous nerinetide or placebo.

Apixaban versus aspirin for stroke prevention in people with subclinical atrial fibrillation and a history of stroke or transient ischaemic attack: subgroup analysis of the ARTESiA randomised controlled trial.

Background: People with subclinical atrial fibrillation are at increased risk of stroke, albeit to a lesser extent than those with clinical atrial fibrillation, leading to an ongoing debate regarding the benefit of anticoagulation in these individuals. In the ARTESiA trial, the direct-acting oral anticoagulant apixaban reduced stroke or systemic embolism compared with aspirin in people with subclinical atrial fibrillation, but the risk of major bleeding was increased with apixaban. In a prespecified subgroup analysis of ARTESiA, we tested the hypothesis that people with subclinical atrial fibrillation and a history of stroke or transient ischaemic attack, who are known to have an increased risk of recurrent stroke, would show a greater benefit from oral anticoagulation for secondary stroke prevention compared with those without a history of stroke or transient ischaemic attack.

Importance of infarct topography in determination of stroke mechanism and recurrence risk: a post-hoc analysis of the dabigatran acute treatment of stroke trial.

Objective: To evaluate the relationship between infarct pattern, inferred stroke mechanism and risk of recurrence in patients with ischaemic stroke. The question is clinically relevant to optimise secondary stroke prevention investigations and treatment.

Design: We conducted a retrospective analysis of the dabigatran treatment of acute stroke II (DATAS II) trial (ClinicalTrials.

Automatic Matching Algorithms to Identify Eligible Participants for Stroke Trials: A Proof-of-Concept Study.

Background: Clinical trials often struggle to recruit enough participants, with only 10% of eligible patients enrolling. This is concerning for conditions like stroke, where timely decision-making is crucial. Frontline clinicians typically screen patients manually, but this approach can be overwhelming and lead to many eligible patients being overlooked.

Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion.

Thrombolytic therapies for acute ischemic stroke are widely available but only result in recanalization early enough, to be therapeutically useful, in 10% to 30% of cases. This large gap in treatment effectiveness could be filled by novel therapies that can increase the effectiveness of thrombus clearance without significantly increasing the risk of harm. This focused update will describe the current state of emerging adjuvant treatments for acute ischemic stroke reperfusion.

The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.

Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.

Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.

Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial.

Two-stage convolutional neural network for segmentation and detection of carotid web on CT angiography.

Background: Carotid web (CaW) is a risk factor for ischemic stroke, mainly in young patients with stroke of undetermined etiology. Its detection is challenging, especially among non-experienced physicians.

Methods: We included patients with CaW from six international trials and registries of patients with acute ischemic stroke.

Clinical Predictors of Acute Ischemia in Patients with Low-Risk Neurological Deficits.

Background: Diagnosis of acute ischemia typically relies on evidence of ischemic lesions on magnetic resonance imaging (MRI), a limited diagnostic resource. We aimed to determine associations of clinical variables and acute infarcts on MRI in patients with suspected low-risk transient ischemic attack (TIA) and minor stroke and to assess their predictive ability.

Methods: We conducted a post-hoc analysis of the Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study, a prospective, multicenter cohort study investigating the frequency of acute infarcts in patients with low-risk neurological symptoms.

Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial.

Background: Individuals with minor ischaemic stroke and intracranial occlusion are at increased risk of poor outcomes. Intravenous thrombolysis with tenecteplase might improve outcomes in this population. We aimed to test the superiority of intravenous tenecteplase over non-thrombolytic standard of care in patients with minor ischaemic stroke and intracranial occlusion or focal perfusion abnormality.