Advances in the management of acute ischemic stroke

Abstract

Purpose of reviewThis review aims to summarize the therapeutic advances and evidence in the medical management of acute ischemic stroke (AIS). Recent evidence comparing the efficacy and safety of tenecteplase (TNK) with alteplase for intravenous thrombolysis (IVT) in AIS will be highlighted. Recent advances and evidence on improving micro-circulation following endovascular procedures and neuroprotection will be reviewed.Recent findingsA significant number of randomized control studies now support the use of tenecteplase for IVT in AIS. TNK 0.25 mg/kg single bolus is as effective and well tolerated as alteplase 0.9 mg/kg infusion for IVT in AIS. Evidence from randomized control trials (RCTs) has shown effective and well tolerated expansion of the therapeutic window of IVT in the wake-up stroke and up to 9 h after last seen well, using advanced neuroimaging with computed tomography perfusion/MRI. Early evidence suggests that intra-arterial alteplase may help improve microcirculation in patients with large vessel occlusion following successful thrombectomy. However, more trials are required to confirm the results. Similarly, early evidence from a recent RCT showed that remote ischemic conditioning confers potential neuroprotection and improves outcomes in AIS.SummaryConverging evidence has demonstrated that for patients with ischemic stroke presenting at under 4.5 h from the onset, TNK is comparable to alteplase. These data along with the practical advantages of TNK have resulted in a shift to replace intravenous TNK as the standard for thrombolysis. Ongoing studies of IVT with TNK are focussed on defining the optimal dose, expanding the time window with multimodal imaging and defining the role of thrombolysis for bridging patients with stroke due to large vessel occlusion.

Tenecteplase versus alteplase for the treatment of acute ischemic stroke: a meta-analysis of randomized controlled trials

“…Among patients with LVO and AIS within 4.5 h of stroke onset, the guidelines [ 33 ] recommended intravenous thrombolysis with 0.25 mg/kg of tenecteplase over alteplase. Nevertheless, for the treatment of AIS, the optimal dose of tenecteplase has not yet to be well defined at present [ 34 ]. Most of previous studies focused on the dose range of tenecteplase from 0.1 to 0.4 mg/kg, and the commonly used dose was 0.25 mg/kg.…”

Increasing reproducibility in preclinical stroke research: the correlation of immunofluorescence intensity measurements and Western blot analyses strongly depends on antibody clonality and tissue pre-treatment in a mouse model of focal cerebral ischemia

“…Further, we investigated, whether the obtained results actually correlate with protein levels as given by Western blot analyses. For this purpose, the tissue was analyzed 24 h after ischemia induction, which not only represents one of the most often applied time points in preclinical stroke research, but also reflects the clinical situation, where efforts are made to prolong the therapeutic time frame for concerned patients ( Nair et al, 2023 ).…”

The value of RPS15 and MRPS27 in ischemic stroke

“…Early rehabilitation treatment of stroke can minimize the impact of disability on normal life, and rehabilitation treatment should be based on the condition as soon as possible. [ 14 , 15 ] In-depth exploration of the molecular mechanism of ischemic stroke is very important for the study of targeted drugs. The main result of this study is that RPS15 and MRPS27 are the core genes of ischemic stroke.…”