Outcome Of Thrombolysis Research Articles

Transport time as a potential limiting factor for thrombolytic treatment of stroke in Norway

BackgroundRapid diagnosis and treatment of stroke is important for good outcome. In some cases, patients with ischemic stroke arrive at hospital too late for reperfusion therapy. This may be the case especially in rural areas where time spent during transport may delay or even preclude thrombolytic treatment after hospital arrival. We aimed to estimate the extent and clinical relevance of this problem in the Norwegian population.MethodsWe collected data for all reported acute ischemic strokes for the years 2017 and 2018. Transport times from home to hospital were calculated from geographical data and related to frequency of thrombolysis, thrombectomy and clinical outcome after 3 months.ResultsThe frequency of reperfusion therapy decreased significantly as transport time increased. Six percent (564) of 9 428 patients were classified as having a prolonged time in transport. In this group, frequency of intravenous thrombolysis was 10,5% as opposed to 28,2% when prolonged transport was not present. Thrombectomy was performed in 2.1% versus 4.9% in the two groups respectively. We did not find a statistically significant difference between the two groups with regard to clinical outcome as judged by the modified Rankin Scale.ConclusionIn the years 2017 and 2018 a relatively small group of Norwegian patients with prolonged time in transport was disfavored concerning access to reperfusion therapy for ischemic stroke. In such cases a prehospital solution for diagnostic work up and treatment might improve access to acute stroke treatment.

The Optimal Time of Percutaneous Pharmacomechanical Thrombolysis for the Treatment of Thrombosed Hemodialysis Arteriovenous Graft.

The optimal time for the salvaging of thrombosed hemodialysis grafts is controversial. This study was aimed at determining the optimal time related to the outcome of percutaneous pharmacomechanical thrombolysis (PMT) for the treatment of thrombosed arteriovenous graft (AVG). This was a retrospective study of 191 hemodialysis patients who underwent PMT for thrombosed AVG from April 2014 to December 2021. Demographic data and details of the procedure were recorded. The procedural success rate related to the onset time of PMT was analyzed. The postinterventional circuit primary assisted patency rate was presented by the Kaplan-Meier curve. A total of 191 hemodialysis patients, 101 females and 90 males, were enrolled. Their median age was 66 years (interquartile range of 58-75 years). The majority type of thrombosed AVG was brachiocephalic loop graft (60.2%). The procedural success rate of PMT that was performed ≤ 48 h was 86.2%. There was a statistically significant procedural success rate of PMT in the group with an onset of treatment ≤ 48 h compared to > 48 h (odds ratio = 2.77; 95% confidence interval = 1.06, 7.28; p = 0.037). The median postintervention circuit primary assisted patency in the group of treatment ≤ 48 and > 48 h was 7.3 and 3.9 months (p = 0.023), respectively. From this study, the optimal time of PMT for treatment of thrombosed AVG should be within 48 h after onset of thrombosis for enhancing procedural success and patency rates.

A new nomogram for predicting 90-day outcomes of intravenous thrombolysis in patients with acute ischaemic stroke.

The aim of this study was to construct and validate a new nomogram to predict the risk of poor outcome in patients with acute ischemic stroke (AIS) after intravenous thrombolytic therapy (IVT). A total of 425 patients who received IVT within 4.5 h of stroke onset were included in a retrospective study. All the patients were divided into training (70%, n = 298) and validation cohorts (30%, n = 127). Poor outcome (defined as a 90-day modified Rankin Scale score 3-5) was the primary outcome. Logistic regression was used for analysis of independent risk factors for poor outcome in patients with AIS. Nomograms of poor outcome in AIS patients were constructed using R software. Discrimination and calibration of the models were assessed using area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots. Multifactorial logistic regression analysis showed that SII (OR = 1.001, 95% CI: 1.000-1.002, p = 0.008), SIRI (OR = 1.584, 95% CI: 1.122-2.236, p = 0.009), NIHSS (OR = 1.101, 95% CI: 1.044-1.160, p < 0.001), and history of diabetes mellitus (OR = 2.582, 95% CI: 1.285-5.188, p = 0.008) were the independent risk factors for the occurrence of poor outcome in AIS patients. The poor outcome nomogram for AIS patients was constructed based on the above independent risk factors. The training and validation cohort AUCs of the nomogram were 0.854 (95% CI: 0.807-0.901) and 0.855 (95% CI: 0.783-0.927), respectively. The prediction models were well calibrated in both the training and validation cohorts. The net benefit of the nomograms was better when the threshold probability ranges were 4.28-66.4% and 4.01-67.8% for the training and validation cohorts, respectively. New nomogram includes NIHSS, SII, SIRI and diabetes as variables with the potential to predict the risk of 90-day outcomes in patients with AIS following IVT.

Safety and outcomes of intravenous thrombolysis in acute ischemic stroke with intracranial artery dissection.

Intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) related to underlying intracranial artery dissection (IAD) poses potential risks, including the exacerbation of intramural hematoma and the rupture of the dissected arterial wall. However, the safety of IVT in this specific population remains uncertain. This study aimed to assess whether IAD is associated with an increased risk of intracranial hemorrhage (ICH) following IVT and to evaluate its impact on functional outcomes. This retrospective matched-pair cohort study used a nationwide inpatient database that includes discharge abstracts and administrative claims data in Japan. We included adult patients with AIS treated with IVT between July 2010 and July 2024. We excluded patients with carotid or vertebral artery dissections due to difficulties distinguishing between intracranial and extracranial involvement, those lacking premorbid/discharge modified Rankin Scale (mRS) data, and those who received intra-arterial thrombolysis. Patients with IAD were matched 1:4 with non-IAD controls based on age, sex, premorbid mRS, endovascular treatment (EVT), and teaching hospital status. We assessed ICH, functional independence at discharge (mRS = 0-2), and in-hospital mortality using multivariable logistic regression with generalized estimating equations to account for clustering within matched pairs, adjusting for age, sex, premorbid mRS, body mass index, smoking history, hypertension, diabetes mellitus, atrial fibrillation, coagulopathy, Japan Coma Scale, EVT, and teaching hospital status. Of 83,139 patients with AIS treated with IVT, 242 (0.3%) had underlying IAD (median age = 54 (46-67) years; 34% women). These patients were matched with 968 non-IAD controls. IAD was associated with a higher risk of ICH (odds ratio (OR) = 3.18; 95% confidence interval (CI) = 1.26-8.06) and a lower likelihood of functional independence at discharge (OR = 0.51; 95% CI = 0.37-0.72), but not with increased in-hospital mortality (OR = 1.09; 95% CI = 0.50-2.38). Patients with underlying IAD may face an increased risk of ICH and a reduced chance of functional recovery following IVT compared to those without.

Stroke-Related Factors Influencing Thrombolysis Eligibility and Outcomes.

Intravenous thrombolysis (IVT) improves outcomes of acute ischemic stroke (AIS) when timely administered. The aim of this study was to collect and analyze data of stroke-related factors which may influence the performance of stroke-related rescue chains, the use of IVT, and patients' outcomes. This study enrolled patients with AIS admitted to our Stroke Unit (SU) between January 1, 2023, and December 31, 2023. We investigated whether age, occurrence of baseline disabling deficits, stroke severity, or stroke location influenced the median Onset-to-Door Time (ODT), the chance of receiving IVT, or the outcomes of AIS in our facility. A total of 208 patients were enrolled. Patients who received IVT had higher baseline National Institute of Health Stroke Scale (NIHSS) scores (12.26±1.2) than those who did not (6.77±0.51) (P<0.0001). Patients with IVT further showed a greater strength deficit, less ataxia, and lower median ODT (108±20min) than patients with NO IVT (720±67) (P<0.0001). Weakness of the lower limbs and higher total NIHSS predicted ODT≤ 3.5 hours and the use of IVT. Ataxia and Posterior Circulation Stroke slowed the rescue chain and were negatively correlated with the use of IVT. Stroke-related factors may slow the rescue chain and affect the application of IVT for AIS. New evaluation strategies are warranted to overcome the detrimental effects of these factors and to allow clinicians to effectively manage strokes of any severity and location.

Abstract WP11: Efficacy and Safety Outcomes of thrombolysis for stroke in Low- and Middle-Income countries: Systematic Review and Metanalysis

Abstract WP11: Efficacy and Safety Outcomes of thrombolysis for stroke in Low- and Middle-Income countries: Systematic Review and Metanalysis

Relationship between triglyceride-glucose index and intravenous thrombolysis outcomes for acute ischemic stroke

Aims: The aim of this study was to investigate the effect of triglyceride glucose index, a marker of insulin resistance, on early neurological deterioration (END), development of intracerebral hemorrhage and hemorrhagic transformation and mortality in patients receiving intravenous thrombolytic therapy for acute ischemic stroke. Methods: This retrospective study included 71 patients with acute ischemic stroke who received intravenous tissue plasminogen activator. Demographic data, clinical and radiological findings, fasting glucose and lipid profile, END, hemorrhage development and mortality rates were analyzed. We also calculated the triglyceride glucose (TyG) index and examined its correlation with early neurological deterioration, hemorrhage development and mortality. Results: The median age was 74 years (41-88), with a female predominance of 54.9%. The incidence of intracerebral hemorrhage was 9.6%, while END occurred in 39.6% of cases, and the 30-day mortality rate was 28.2%. The mean TyG index was 7.8 (2.8-27.6). The receiver operating characteristic curve analysis indicated that the TyG index predicted mortality with an area under the curve of 84.4%, a sensitivity of 85%, and a specificity of 82.35% in patients with a TyG index above 10.01 (p

Safe Implementation of Treatments in Stroke: a study on intravenous thrombolysis in patients over 80 years of age with acute ischaemic stroke

ObjectivesTo investigate the safety and efficacy outcomes of intravenous thrombolysis (IVT) in patients aged >80 years with acute ischaemic stroke (AIS) after IVT was approved in this patient population in...

Tenecteplase vs Reteplase in Patients with Acute ST-Elevation Myocardial Infarction: A Retrospective Cohort Study.

The aim of this study is to compare the efficacy and safety of both agents in patients with acute STEMI. This was a multicenter retrospective observational study comparing tenecteplase and reteplase in patients with acute STEMI. The primary outcome was the incidence of failed thrombolysis. Secondary outcomes included the incidence of major bleeding, cardiogenic shock, re-infarction and mortality. A total of 282 patients were included, 229 and 53 received tenecteplase and reteplase, respectively. The incidence of failed thrombolysis was 33.2% in the tenecteplase group compared to 20.8% in the reteplase group (adjusted odds ratio 0.53, 95% confidence interval 0.25-1.1; p = 0.089). The incidence of major bleeding was 0.9% in the tenecteplase group and 5.7% in the reteplase group (p = 0.017). There was no significant difference in mortality or other secondary outcomes. There was no difference in the primary outcome of failed thrombolysis between tenecteplase and reteplase; however, major bleeding events were significantly higher in the reteplase group. Randomized controlled trials are needed to confirm our findings.

Arterial pressure during first day after intravenous thrombolysis and acute ischemic stroke outcomes: single-center randomized controlled study

Introduction. Blood pressure optimization during and after reperfusion in patients with acute ischemic stroke can reduce the risk of hemorrhagic complications and improve functional recovery. Several randomized controlled trials of different target blood pressure values have been published with varying results.The objective was to evaluate the effect of intensive hypotensive therapy in the first day after intravenous thrombolysis on outcomes of acute ischemic stroke and incidence of complications.Materials and methods. A single-center open label randomized controlled trial was conducted. Patients older than 18 years with acute ischemic stroke who underwent reperfusion were included. Patients were randomized into 2 groups: with a target systolic blood pressure of 161–185 mm Hg on the first day (control group) versus &lt; 160 mm Hg (intensive hypotensive therapy group). The primary end points were mortality and modified Rankin Scale score at day 90 from the onset of stroke.Results. The final analysis included 69 patients. In the intensive hypotensive therapy group, mortality rate did not differ from the control group: OR 1.1 [95% CI 0.3 to 4.8] (p = 0.896). The median modified Rankin scale score at day 90 in the control group was 2 (1; 3.8) versus 2 (1; 3.5) in the intensive hypotensive therapy group (p = 0.812).Conclusion. Intensive hypotensive therapy at the first day after intravenous thrombolysis in acute ischemic stroke patients with target values of systolic blood pressure &lt; 160 mm Hg compared to conventional values of 161–185 mm Hg neither improved functional outcome nor decreased mortality and complications rate on day 90 from the onset of stroke.

Comparing Real-World Outcomes of Catheter-Directed Thrombolysis and Catheter-Based Thrombectomy in Acute Pulmonary Embolism: A Post PEERLESS Analysis.

The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk. This study aims to address this gap by comparing real-world outcomes of CDT and CBT in patients with acute PE. This retrospective analysis included patients who underwent CDT and CBT at two tertiary care centers from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation. Secondary outcomes included major bleeding and intracranial hemorrhage (ICH). Inverse probability treatment weighting (IPTW) was used to adjust for baseline variables. A total of 162 (mean age 58 years, 45.7% women, 17.3% high-risk, 28% contraindication to lytics, 28% CDT, 72% CBT) patients were included, with 12.4% patients experiencing the primary outcome. There was no difference in the rates of the primary outcome between CBT versus CDT (11.2% vs. 15.2%, IPTW HR: 0.80; 95% CI: 0.27-2.38, p = 0.69). CBT was associated with a lower risk of hemodynamic decompensation (5% vs. 21.7%, p = 0.036), major bleeding (7.8% vs. 17.4%, IPTW HR 0.26; 95% CI: 0.07-0.95, p = 0.042) and ICH (0 vs. 4.3%, p = 0.024) compared to CDT. Among a real-world cohort of patients with acute PE with higher bleeding risk than PEERLESS undergoing catheter-based therapies, CBT was associated with a lower rate of hemodynamic deterioration, major bleeding, and ICH with similar rate of primary composite outcome when compared with CDT. Additional randomized controlled trials are needed to validate these findings.

Comparison of safety and efficacy outcomes of intravenous thrombolysis in posterior vs. anterior circulation stroke

Background &amp; Objectives: Most previous large clinical studies of intravenous thrombolysis (IVT) focused on anterior circulation stroke (ACS). However, the results from ACS studies cannot fully represent posterior circulation stroke (PCS) patients due to their differences in symptoms, signs and etiologies. This study aimed to compare whether there are differences in thrombolysis outcomes between ACS and PCS patients who underwent IVT alone, and to explore predictors of outcomes in PCS after IVT. Methods: We included acute ischemic stroke (AIS) patients who underwent IVT and divided them into ACS and PCS groups according to clinical symptoms and neuroimaging examinations. A series of baseline data were collected while symptomatic intracranial hemorrhage (sICH), hemorrhagic cerebral infarction (HI), parenchymal hemorrhage (PH), all intracranial hemorrhage (aICH), mortality and the modified Rankin Scale (mRS) score were employed to assess thrombolysis outcomes. Results: Among 321 IVT-treated AIS patients, 87 had PCS. The incidence of sICH (1.1% vs. 9.8%, p=0.007), PH (1.1% vs. 9.8%, p=0.007), and aICH (4.6% vs. 15.8%, p=0.008) were lower in PCS than in ACS. A higher proportion of PCS achieved an excellent recovery (56.3% vs. 43.6%, p=0.042) and functional independence (66.7% vs. 53.8%, p=0.039) at 3 months poststroke. Logistic regression analysis identified the National Institutes of Health Stroke Scale (NIHSS) score (p&lt;0.001) and pre-event antiplatelet therapy (p=0.005) as significant predictors of excellent recovery and the NIHSS score (p&lt;0.001) as a unique predictor of functional independence at 90 days in PCS. Conclusions: PCS patients had a lower risk of intracranial hemorrhage complications and better functional outcomes after IVT alone.

The role of neutrophils in tPA thrombolysis after stroke: a malicious troublemaker.

Acute ischemic stroke represents a critical, life-threatening condition affecting the central nervous system. Intravenous thrombolysis with tissue plasminogen activator (tPA) remains a cornerstone for achieving vascular recanalization in such patients; however, its therapeutic utility is limited, with only approximately 10% of patients benefiting due to the narrow therapeutic window and significant risk of hemorrhagic transformation. Enhancing the efficacy of tPA thrombolysis is therefore imperative. Neutrophils have been identified as key modulators of thrombolytic outcomes, interacting with tPA post-stroke to influence treatment effectiveness. The binding of tPA to low-density lipoprotein receptor-related protein 1 (LRP-1) on neutrophil surfaces induces degranulation and formation of neutrophil extracellular traps (NETs). Conversely, neutrophils impede the thrombolytic action of tPA by obstructing its interaction with fibrin and activating platelets. These findings suggest that targeting neutrophils may hold promise for improving thrombolysis outcomes. This review explores the role of neutrophils in tPA-mediated thrombolysis following acute ischemic stroke, examines neutrophil-associated biomarkers, and outlines potential strategies for enhancing tPA efficacy.

Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment.

Direct oral anticoagulants are the primary stroke prevention option in patients with atrial fibrillation. Anticoagulant use before stroke, however, might inhibit clinician comfort with thrombolysis if a stroke does occur. Resuming anticoagulants after ischemic stroke is also problematic for fear of hemorrhage. We describe extensive literature showing that thrombolysis is safe after stroke with direct anticoagulant use. Early reinstitution of direct anticoagulant treatment is associated with lower risk of embolic recurrence and lower hemorrhage risk. The use of direct anticoagulants before, during, and after thrombolysis appears to be safe and is likely to promote improved outcomes after ischemic stroke. ANN NEUROL 2024;96:871-886.

Characteristics, temporal trends and outcomes of intravenous thrombolysis in Chinese patients aged>80 years who had a stroke.

To date, no large cohort study has investigated the effects of intravenous thrombolysis (IVT) in Chinese patients aged over 80 years who had a stroke. This study aimed to assess the trends in the use of alteplase, the clinical characteristics and the outcomes of Chinese patients aged above 80 years who had an acute ischaemic stroke. Data for this analysis were obtained from the China Stroke Center Alliance programme, a nationwide, multicentre, prospective registry encompassing 1751 hospitals across 31 provinces, covering the period from 1 January 2018 to 14 December 2022. The primary outcome was defined as a modified Rankin Scale (mRS) Score of 0-2 at discharge. Secondary outcomes included an mRS Score of 0-1 and independent ambulation on discharge. Safety outcomes assessed were in-hospital mortality and symptomatic intracranial haemorrhage (sICH). Out of 30 902 patients over 80 years old who qualified for thrombolysis, 8673 (median age (IQR), 84 (82-87) years) received alteplase treatment. Patients administered alteplase demonstrated improved short-term functional outcomes, such as an mRS Score of 0-2 (adjusted OR (aOR) 1.12, 95% CI, 1.06 to 1.18, p<0.001), an mRS Score of 0-1 (aOR 1.14, 95% CI, 1.08 to 1.19, p<0.001) and independent ambulation at discharge (aOR 1.14, 95% CI, 1.08 to 1.20, p<0.001). Moreover, no significant increase was observed in the risk of in-hospital mortality (aOR 1.12, 95% CI, 0.93 to 1.35; p=0.23). However, the risk of sICH was significantly higher among patients treated with alteplase (aOR 3.22, 95% CI, 2.77 to 3.75; p<0.001). IVT with alteplase in elderly patients who had a stroke resulted in improved short-term functional outcomes without elevating the risk of in-hospital mortality. Nonetheless, this population remains at a higher risk of sICH.

Catheter-Directed Thrombolysis for (Not Immediately) Threatened Acute Lower Limb Ischemia: Clinical Outcome and Efficacy.

The objective of this study was to examine the short- and midterm outcomes of catheter-directed thrombolysis (CDT) for acute lower limb ischemia (ALI), classes Rutherford 1 and 2, with specific attention to functional outcome. This retrospective study included patients with ALI treated with CDT from 2 vascular centers between May 2018 and April 2021. Cases were analyzed in groups according to the Rutherford (1 and 2) classification. The primary endpoint was functional outcome during follow-up, assessed by Rutherford's chronic limb ischemia classification. Functional outcomes over time were analyzed by generalized estimating equations. Kaplan-Meier analysis was used to estimate reintervention, amputation, survival, and reintervention-free survival rates. Two hundred cases were included (Rutherford 1, n = 51; Rutherford 2, n = 149). Total median treatment duration was 27 hours in the Rutherford 1 group and 39 hours in the Rutherford 2 group (P= 0.120). Initial clinical success was high (Rutherford 1, 82% vs Rutherford 2, 89%; P= 0.253). Complications were comparable between the 2 groups: major bleeding 8% vs 10% (P= 0.634), major amputation 4% vs 7% (P= 0.603), and mortality 6% vs 6% (P= 0.967). Median follow-up was 32 months (0-63 months). During follow-up, there was a high number of reinterventions (43%) and amputations (20%) in patients with Rutherford 1 limb ischemia, which was comparable to patients with Rutherford 2 limb ischemia. Fifty-six percent of the patients with Rutherford 1 limb ischemia reaching 2 years of follow-up were asymptomatic, 20% had mild and 16% had moderate to severe claudication. Initial clinical success following CDT and not immediately threatened ischemia at presentation are associated with improved functional outcomes during follow-up (P < 0.001 and P= 0.009, respectively). In our cohort, CDT was effective in reestablishing arterial flow for not immediately threatened ALI. Patients with Rutherford 1 limb ischemia who receive CDT had a more favorable functional outcome than patients with more severe limb ischemia (Rutherford 2). However, reinterventions were required frequently, and there was a substantial risk of complications. Acute lower limb ischemia (ALI) does not immediately jeopardize limb survival in patients with Rutherford 1 limb ischemia but can induce disabling claudication. In such patients, catheter-directed thrombolysis (CDT) is often performed to improve functional outcome. However, previous reports warned about the complications of CDT, and so far, mid- and long-term functional outcomes have not been reported. This study, in which a large cohort of patients with ALI was included, demonstrates a high technical success of CDT for not immediately threatened ALI with more favorable functional outcomes when compared with those with threatened limbs. Nevertheless, major complications pose a serious risk, and the need for reinterventions in the long term is high.

Effect of Heparin Reversal by Protamine Sulfate on the Outcome of Thrombolysis in Acute Ischemic Stroke after Percutaneous Coronary Intervention

Abstract Background Acute ischemic stroke (AIS) after percutaneous cardiac catheterization (PCI) is a known complication with incidence reports of ranges between 0.2% and 0.5%. It is associated with an in-hospital mortality rate of 20%, with markedly increased long-term mortality (1). Administration of Intravenous thrombolysis (IVT) is the recommended standard of care in acute ischemic stroke during the first 4.5 hours from stroke onset. However, current guidelines exclude intravenous thrombolysis in heparinized patients with partial thromboplastin time (PTT) greater than 40 seconds (2) Protamine is an efficient antidote known for the anticoagulant effect of heparin, and it can neutralize its effect within 5 minutes (3). Aim of the Work To assess the safety of IVT after heparin reversal by protamine sulfate in ischemic Stroke patients After PCI. Patient and Method The total number of patients who developed early IP stroke (within 4.5 hours from the end of PCI) was 42. All of them received loading antiplatelets before PCI. Results out of 21 patients received IVT after heparin reversal by protamine, no patient had died, 2 cases had non symptomatic intracranial hemorrhage (ICH), with significant improvement in stroke parameters and shorter length of stay Conclusion IVT following heparin reversal by protamine in appropriately selected AIS patients appears to be safe from a symptomatic ICH standpoint and may be beneficial. Extreme caution is warranted in applying these results to routine clinical practice. Rather, we suggest that thrombolysis may still be considered in AIS patients on therapeutic heparin who are not candidates for MT

Outcome of intravenous thrombolysis in acute ischemic stroke patients with small vessel disease

Outcome of intravenous thrombolysis in acute ischemic stroke patients with small vessel disease

Neutrophil migration participates in the side effect of recombinant human tissue plasminogen activator.

Ischemic stroke remains a challenge in medical research because of the limited treatment options. Recombinant human tissue plasminogen activator (rtPA) is the primary treatment for recanalization. However, nearly 50% of the patients experience complications that result in ineffective reperfusion. The precise factors contributing to ineffective reperfusion remain unclear; however, recent studies have suggested that immune cells, notably neutrophils, may influence the outcome of rtPA thrombolysis via mechanisms such as the formation of neutrophil extracellular traps. This study aimed to explore the nonthrombolytic effects of rtPA on neutrophils and highlight their contribution to ineffective reperfusion. We evaluated the effects of rtPA treatment on middle cerebral artery occlusion in rats. We also assessed neutrophil infiltration and activation after rtPA treatment invitro and invivo in a small cohort of patients with massive cerebral ischemia (MCI). rtPA increased neutrophil infiltration into the brain microvessels and worsened blood-brain barrier damage during ischemia. It also increased the neutrophil counts of the patients with MCI. Neutrophils play a crucial role in promoting ischemic injury and blood-brain barrier disruption, making them potential therapeutic targets.

Meta-analysis of clinical and safety profiles after reperfusion therapy in acute posterior circulation strokes: insights and implications.

Posterior circulation stroke (PCS) accounts for approximately 20% of all acute ischemic strokes. The optimal reperfusion therapy for PCS management remains uncertain. To evaluate the prevalence and outcomes of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and bridging therapy in PCS patients. We conducted a meta-analysis of 19 studies examining reperfusion therapy outcomes in PCS patients, including 9765 individuals. We pooled prevalence data and assessed associations between reperfusion therapies and clinical, safety, and recanalization outcomes using random-effects models. The pooled prevalence of reperfusion therapies post-acute PCS was 39% for IVT, 54% for EVT, and 48% for bridging therapy. EVT was associated with significantly higher odds of favorable functional outcomes (modified Rankin Score [mRS] 0-3) at 90 days compared to standard medical therapy (odds ratio [OR] = 5.68; 95% confidence interval [CI]=2.07-15.59; P = 0.001). Conversely, bridging therapy was linked to reduced odds of favorable functional outcomes at 90 days compared to EVT (OR = 0.35; 95% CI=0.26-0.47; P < 0.001). Bridging therapy was also significantly associated with lower odds of good functional outcomes (mRS 0-2) (OR = 0.25; 95% CI=0.11-0.54; P < 0.001), reduced risk of symptomatic intracranial hemorrhage (OR = 0.26; 95% CI=0.07-0.68; P = 0.009), lower mortality (OR = 0.13; 95% CI=0.04-0.44; P = 0.001), and less successful recanalization (OR = 0.35; 95% CI=0.13-0.94; P = 0.038) relative to EVT. Our meta-analysis underscores the favorable outcomes associated with EVT in PCS cases. With notable reperfusion rates, understanding factors influencing PCS outcomes can inform patient selection and prognostic considerations.