In AIS due to LVO presenting within 4.5 h of onset, adding tenecteplase to EVT increased functional independence at 90 d.

Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].

Intravenous tenecteplase is associated with a higher incidence of thrombus movement before endovascular treatment for acute ischemic stroke: a secondary analysis of the AcT randomized controlled trial.

Background: Thrombus migration can occur in patients receiving IV thrombolysis for acute stroke. This study compared the effects of IV tenecteplase (0.25 mg/kg) versus alteplase (0.

At 4.5 to 24 h after posterior circulation stroke onset, alteplase vs. standard medical care increased 90-d functional independence.

Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].

Tenecteplase versus Alteplase and First-Pass Reperfusion in Endovascular Thrombectomy.

Background And Purpose: It is unknown whether thrombolysis with IV tenecteplase before endovascular thrombectomy (EVT) influences the probability of first-pass reperfusion when compared with IV alteplase. Therefore, we evaluated the effect of IV thrombolytic choice on this outcome.

Materials And Methods: We investigated the effects of thrombolytic agent (IV tenecteplase or IV alteplase) on first-pass reperfusion in EVT patients from the Alteplase Compared to Tenecteplase in Patients with Acute Ischemic Stroke (AcT) trial.

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.

Factors associated with adverse outcomes following perioperative stroke after noncardiac surgery.

Background: Perioperative stroke is associated with high rates of adverse outcomes. Our objective was to identify factors associated with 30-day mortality, adverse discharge, and length of hospital stay following perioperative stroke among noncardiac surgical patients, and to analyze trends in these outcomes from 2005 to 2020.

Study Design: A retrospective cohort study of noncardiac perioperative stroke patients was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2020).

Cerebral Venous Thrombosis: Selected Persisting Areas of Uncertainty.

Although a rare stroke type, recent large collaborative efforts have further improved the state of knowledge regarding management of cerebral venous thrombosis (CVT). However, several areas of uncertainty remain. In this review, we focus on existing evidence and priorities for future research in some select areas in the acute management and longer-term follow-up of CVT: the role of endovascular therapy, management of CVT associated with head and neck infection, management of CVT associated with head trauma, monitoring for papilledema and vision loss, and the role of prophylactic antiseizure medication.

Outcomes Following Perioperative Stroke in Cardiac Surgery Patients: A Retrospective Cohort Study.

Objectives: To identify independent predictors of 30-day mortality, adverse discharge, and length of hospital stay following a perioperative stroke among cardiac surgical patients, and to measure trends in outcomes over time.

Design: A retrospective cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2020.

Current Practices of Cardiac Monitoring and Early Rhythm-Control Therapy for Atrial Fibrillation and Stroke Prevention.

We conducted an international survey of stroke physicians to assess practices and attitudes toward cardiac monitoring and early rhythm control. A 20-question survey was completed by 241 clinicians representing 61 countries. The minimum duration of actionable atrial fibrillation varied widely, and more than 90% (223/241) of respondents indicated a willingness to enroll patients in a trial assessing the ideal duration of cardiac monitoring.

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.

Incidence Trends and Risk of Recurrent Stroke of Cervical Artery Dissections in the United States Between 2005 and 2019.

Background And Objectives: Cervical artery dissection (CeAD) is a common cause of acute ischemic stroke (AIS), especially in patients younger than 55 years, but data regarding trends and subsequent AIS risk after CeAD remain scarce. We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke.

Methods: We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019).

Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection.

Background: Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.

Methods: This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022.

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.

Novel Network Analysis of County- and Individual-Level Factors Associated With Functional Outcomes After Stroke.

Background: Social determinants are known to impact stroke risk and poststroke outcomes. Using complexity science, we examined interrelations between county- and individual-level social and clinical determinants influencing stroke functional outcomes.

Methods: We examined a retrospective cohort of 2 961 664 patients diagnosed with acute ischemic or hemorrhagic stroke from 2218 US hospitals participating in the Get With The Guidelines-Stroke Registry from 2013 to 2019, linked by ZIP code with the county-level institute for health metrics and evaluation data.

Diffusion tensor imaging after COVID-19 infection: A systematic review.

Background: Most COVID-19 neuroimaging research focuses on clinically evident lesions occurring during the acute period after infection. Chronic effects on brain structure, especially at a microstructural level, are less well defined. Existing advanced neuroimaging studies report inconsistent differences in white matter integrity after COVID-19 infection.

Quantitative brain volume differences between COVID-19 patients and non-COVID-19 volunteers: A systematic review.

Background: The majority of COVID-19 neuroimaging literature focuses on the acute period after infection and clinically evident lesions. The chronic effects of COVID-19 on brain structure are less well defined. There are inconsistencies in the existing structural neuroimaging studies regarding differences in brain volumes after COVID-19 infection.

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.

Intravenous Thrombolysis in Cervical Artery Dissection-Related Stroke: A Nationwide Study.

Background: Although intravenous thrombolysis (IVT) is safe and effective in populations with general stroke, its impact on cervical artery dissection-related acute ischemic stroke (CeAD-AIS) remains unclear. This retrospective study used the National Inpatient Sample to compare outcomes in patients with CeAD-AIS treated with and without IVT.

Methods: We included adult patients with concurrent CeAD and AIS diagnoses ( [], codes) hospitalized from 2016 to 2019.

Efficacy and safety of nerinetide in acute ischaemic stroke in patients undergoing endovascular thrombectomy without previous thrombolysis (ESCAPE-NEXT): a multicentre, double-blind, randomised controlled trial.

Background: In the ESCAPE-NA1 trial, treatment with nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, was associated with improved functional outcome among patients with acute ischaemic stroke due to large vessel occlusion undergoing endovascular thrombectomy without co-treatment with an intravenous thrombolytic agent. There was no benefit when intravenous thrombolytic agent co-treatment was used. We sought to confirm the clinical benefit of nerinetide in the absence of previous intravenous thrombolytic drug treatment.

Comparison of Noncontrast Computed Tomography, Multiphase Computed Tomography Angiography, and Computed Tomography Perfusion to Assess Infarct Growth Rate in Acute Stroke.

Background: Infarct growth rate is remarkably heterogeneous in acute ischemic stroke, reflecting diverse clinical-physiological phenotypes. We compared different methods of estimating infarct growth rate in patients with acute ischemic stroke undergoing thrombectomy using multimodal computed tomography (CT) stroke imaging.

Methods: Secondary analysis of the international ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) which evaluated the effect of nerinetide in patients with large vessel occlusion undergoing thrombectomy.

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.

Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion.

Background: Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear.

Methods: In a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 [no symptoms] to 6 [death]) at 90 days, reported as the percentage of patients with a score of 0 or 1.