The analysis, led by Wenkui Li and colleagues at Chongqing University Three Gorges Hospital in China, pooled data from fifteen randomized clinical trials that tested reperfusion treatments administered between 4.5 and 24 hours after stroke onset or the last time a patient was known to be well. This extended window matters enormously in clinical practice. Roughly one in five ischemic strokes is discovered only when the patient wakes up or is found after the standard 4.5-hour thrombolysis window has closed, leaving clinicians with difficult decisions about whether aggressive intervention can still salvage brain tissue that is starved of blood but not yet irreversibly damaged.

The researchers took particular care to separate patients with radiologically confirmed intracranial large-vessel occlusion, or LVO, from broader mixed populations of stroke patients. Large-vessel occlusion refers to blockages of the major arteries supplying the brain, such as the middle cerebral artery or the basilar artery, and these blockages are the targets that mechanical thrombectomy is designed to clear. Eight of the fifteen trials contributed data to the primary analysis network restricted to confirmed LVO or basilar artery occlusion. The team also ran a sensitivity analysis limited to anterior-circulation occlusions and an exploratory analysis including all available trials, and the direction of findings held consistent across all three networks.

The statistical engine behind the comparison was a Bayesian random-effects consistency model, a framework that allows indirect comparisons between treatments that were never tested against each other in the same trial. Rather than producing a single p-value, Bayesian methods generate a probability distribution around each effect estimate, expressed here as odds ratios with 95 percent credible intervals. The primary outcome was functional independence at 90 days, defined as a score of 0 to 2 on the modified Rankin Scale, the standard measure that captures whether a stroke survivor can live and function without significant assistance.

Against placebo or best medical care, endovascular thrombectomy produced the most consistent and robust evidence of benefit in the confirmed LVO population. The odds of achieving functional independence were nearly tripled, with an odds ratio of 2.93 and a credible interval of 1.40 to 6.53. Excellent functional outcome, meaning a modified Rankin Scale score of 0 to 1, was also significantly more likely with an odds ratio of 2.22. Perhaps most strikingly, thrombectomy reduced 90-day mortality by roughly 29 percent, with an odds ratio of 0.71, and increased the rate of trial-defined recanalization or reperfusion at approximately 24 hours more than fivefold, with an odds ratio of 5.27.

These gains came with a recognized trade-off. Symptomatic intracranial hemorrhage, the most feared complication of reperfusion therapy, was significantly more frequent after thrombectomy, with an odds ratio of 2.65 and a credible interval of 1.28 to 5.81. This elevated bleeding risk is a known consequence of restoring blood flow to tissue that has been deprived for hours, and it underscores why careful imaging selection of patients remains central to extended-window treatment. The benefit-risk calculus still favored intervention decisively, but the analysis makes explicit that the procedure is not without hazard.

The question of whether adding intravenous tenecteplase before thrombectomy, the so-called bridging strategy, improves outcomes received a more equivocal answer. Compared with thrombectomy alone, the combination of tenecteplase plus thrombectomy showed numerically favorable point estimates for functional independence, with an odds ratio of 1.10, and for excellent functional outcome, with an odds ratio of 1.16. However, the credible intervals were wide and crossed unity, spanning 0.34 to 3.52 and 0.52 to 2.64 respectively, meaning the differences were statistically inconclusive. Direct pairwise analyses of the two trials that compared these strategies head-to-head reached similarly uncertain conclusions. The incremental benefit of bridging tenecteplase, the authors conclude, remains unproven.

Tenecteplase given alone, without subsequent thrombectomy, did not show clear differences from placebo or best medical care in the confirmed LVO network. This finding is notable given the recent wave of trials that have established tenecteplase as a potent thrombolytic agent. Drugs such as the ones tested in studies including TNK-PLUS, CHABLIS-T II, and the tenecteplase trials published in the New England Journal of Medicine and JAMA have reshaped acute stroke care in earlier time windows, but the present analysis suggests that in the extended window with a confirmed large-vessel blockage, pharmacological clot dissolution alone is not a substitute for mechanical removal.

The technical sophistication of the analysis deserves emphasis. The researchers searched PubMed, Embase, Web of Science, and the Cochrane Library, assessed risk of bias using the revised Cochrane RoB 2 tool, and evaluated confidence in the network estimates with the CINeMA framework, a structured approach designed specifically for grading the credibility of network meta-analysis findings. All data were derived from published trial reports, and the authors have made their extracted arm-level dataset, analysis code, and CINeMA input files available upon reasonable request, a level of transparency that strengthens the reproducibility of the work.

For clinicians, the practical message is that among imaging-selected patients with confirmed intracranial large-vessel or basilar artery occlusion treated 4.5 to 24 hours after onset, endovascular thrombectomy carries the most consistent evidence of benefit, and the routine addition of tenecteplase before the procedure cannot yet be justified as superior. For the growing population of patients whose strokes are discovered late, that clarity is more than academic. It means the fastest route to the angiography suite, not the pharmacy, offers the best documented chance of walking out of the hospital independently.

Subject of Research: Comparative effectiveness of thrombolytics and thrombectomy in extended-window acute ischemic stroke with large-vessel occlusion

Article Title: Tenecteplase, alteplase, and endovascular thrombectomy in extended-window acute ischemic stroke with intracranial large-vessel occlusion: a Bayesian network meta-analysis

Article References: Li, W., Wu, C., Deng, R., Zhou, J., Li, L., Liu, Y., & Chen, S. (2026). Tenecteplase, alteplase, and endovascular thrombectomy in extended-window acute ischemic stroke with intracranial large-vessel occlusion: a Bayesian network meta-analysis. Journal of Neurology, 273(11), Article 666. https://doi.org/10.1007/s00415-026-14201-5

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DOI: 10.1007/s00415-026-14201-5

Keywords: stroke, endovascular thrombectomy, tenecteplase, alteplase, network meta-analysis, neurology, large-vessel occlusion, endovascular, thrombectomy, extended-window, acute, ischemic

The research team, led by Jesús Antonio Rodríguez Santos and colleagues at the National Autonomous University of Honduras, conducted a retrospective, consecutive case series of every acute ischemic stroke presentation to the hospital’s Internal Medicine Emergency Service between 1 October and 30 November 2025. Because they screened all arrivals rather than a selected sample, the cohort functions as a census for the period: 23 patients, median age 70 years, 14 of them male, and none thrombolyzed. The institutional thrombolysis rate for those two months was therefore exactly zero percent.

The clinical picture of the cohort was stark. Extreme poverty, defined as two or more unsatisfied basic needs in the household, affected 14 of the 23 patients, or 60.9 percent. Hypertension was nearly universal, present in 95.7 percent of patients, and diabetes in roughly a third. Most patients arrived with moderately severe deficits, with 82.6 percent falling in the middle range of the National Institutes of Health Stroke Scale, between scores of 5 and 25. These are precisely the patients in whom timely reperfusion can mean the difference between independent living and permanent disability.

Timing, however, had already eliminated most of them before any treatment decision could be made. The median onset-to-door time was 10 hours, with an interquartile range of 7 to 15 hours and individual delays stretching to 96 hours. Only one of the 22 patients with a recorded onset time arrived within the 4.5-hour window in which intravenous thrombolysis is standard. This pattern of prehospital delay is well documented in low- and middle-income countries, where stroke awareness, ambulance access, and geographic barriers conspire to consume the most treatment-responsive hours of the illness.

What makes the Honduran data distinctive is what happened next. The researchers constructed a thrombolysis eligibility cascade, a stepwise accounting of how many patients remain potentially treatable as each barrier is applied. Of 23 patients, the pool collapsed to a single individual after the time window criterion. That patient had no absolute contraindication to thrombolysis under the 2019 American Heart Association and American Stroke Association guidelines. Yet the drug, recombinant tissue plasminogen activator, was unavailable. Not scarce, not rationed, but entirely absent. The cascade terminated at zero treated patients, with the final and decisive loss attributable to supply alone.

The contrast with other system components is the study’s most consequential finding. Neuroimaging was available for 95.7 percent of patients, with a median door-to-imaging time of 3 hours. An institutional stroke protocol and trained personnel existed for the same proportion. In other words, the diagnostic and organizational machinery of acute stroke care was largely operational. The bottleneck was neither knowledge nor equipment but the physical presence of a vial of alteplase, a drug that has been standard of care worldwide since the mid-1990s.

The authors are careful about interpretation, and rightly so. With a single group and a constant outcome, no statistical hypothesis about why patients went untreated can be tested, and the study explicitly avoids causal claims. The 61-day window may have coincided with a particular shortage episode, so the findings cannot be generalized to all Honduran hospitals or all time periods. Data came from retrospective records, symptom onset times were often self-reported, and the admission stroke severity was captured in broad categories rather than as a continuous score. These are honest limitations, and the researchers document their data corrections transparently, including one entry error in a discharge severity score that was identified and fixed during chart review.

Even without thrombolysis, the natural history of untreated arterial occlusion played out in the cohort. In-hospital complications occurred in just over half of patients, most frequently hemorrhagic transformation of the index infarct, which affected four patients and was confirmed by computed tomography, since magnetic resonance imaging was not operational during the study period. Two patients died, an in-hospital mortality rate of 8.7 percent, consistent with figures from other Latin American stroke-unit registries. Among survivors, the median discharge stroke severity remained at 11 on the NIHSS, and only five of the 20 patients with an assessable modified Rankin Scale score achieved a good functional outcome, defined as a score of 0 to 2. The rest left the hospital with residual disability that timely reperfusion might have prevented or attenuated.

The study’s exploratory analyses reinforce a familiar prognostic principle: early neurological severity tracks with eventual disability. The NIHSS score at 24 to 72 hours correlated strongly with discharge modified Rankin Scale score, with a Spearman correlation coefficient of 0.79. But the authors emphasize that these hypothesis-generating findings, like the rest of the study, describe the cohort rather than estimate the effect of any single factor on treatment probability.

The practical implication is unusually direct. In a center where imaging capacity and trained staff already exist, securing an uninterrupted thrombolytic supply is the single most consequential intervention, and investments in stroke pathways or public awareness campaigns cannot translate into treatment until that prerequisite is met. Reducing prehospital delay through community education and emergency prenotification would enlarge the pool of window-eligible patients, but only once the drug is on the shelf. Quality-improvement programs elsewhere in Latin America have demonstrated that adherence to acute stroke therapies can improve within public systems, suggesting that organizational gains are achievable once the structural barrier falls. For the researchers, the path forward includes prospective, multicenter registries that capture both treated and untreated strokes, routine monitoring of drug supply, and longer-term evaluation of access to endovascular thrombectomy. Until then, the study stands as a patient-level illustration of a supply-side gap that regional reviews have described in the abstract: in much of Central America, the limiting reagent in stroke care is not expertise or equipment, but the drug itself.

Subject of Research: Barriers to intravenous thrombolysis in acute ischemic stroke at a Honduran national referral hospital

Article Title: Barriers to intravenous thrombolysis in acute ischemic stroke: a retrospective case report series from Honduras

Article References: Santos, J. A. R., Pineda, I., Cardona, E., Maradiaga, C., Galeano, J., Giacaman, L., & Reyes-Garcia, S. Z. (2026). Barriers to intravenous thrombolysis in acute ischemic stroke: a retrospective case report series from Honduras. Frontiers in Stroke, 5, Article 1946997. https://doi.org/10.3389/fstro.2026.1946997

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DOI: 10.3389/fstro.2026.1946997

Keywords: stroke, thrombolysis, acute ischemic stroke, Honduras, health systems, low- and middle-income countries, reperfusion, alteplase, health equity, stroke care barriers, Latin America, drug availability

The study, led by Irene Scala of the Cerebrovascular Unit at Fondazione IRCCS Istituto Neurologico Carlo Besta in Milan and conducted on behalf of the Italian Stroke Association (ISA)-Young, set out to answer a deceptively simple question: what actually happens when patients receive repeated intravenous thrombolysis (RIVT) for a recurrent acute ischemic stroke within 90 days of a previous thrombolysis-treated event? The researchers systematically screened the literature and identified 28 reports describing 63 patients who underwent the procedure, with individual patient-level data available for 44 of those cases. That patient-level granularity matters enormously in a field dominated by small case series, because it allowed the team to analyze outcomes at the level of individual strokes rather than pooled study averages, reducing the aggregation bias that has plagued earlier reviews.

The headline finding is striking. Among patients who received a second course of intravenous thrombolysis within the three-month window, 66.7 percent achieved a favorable functional outcome — a proportion that compares respectably with outcomes reported for first-time thrombolysis in routine clinical registries. The median interval between the two treatments was just 7.5 days, meaning most of these patients were re-dosed while their initial infarcts were still biologically fresh, precisely the scenario in which the feared hemorrhagic risk was thought to be highest. Yet across the entire dataset, not a single case of symptomatic intracranial hemorrhage (sICH) — the dreaded complication that the three-month exclusion criterion was designed to prevent — was recorded after repeated thrombolysis.

Formal meta-analysis reinforced the picture. The pooled odds ratio for better functional outcomes after repeated thrombolysis was 1.52, with a 95 percent confidence interval of 0.97 to 2.39 and zero heterogeneity across studies (I² = 0%). The confidence interval crosses one, so the trend toward benefit does not reach statistical significance, but the direction is consistent and the absence of heterogeneity suggests the underlying case reports tell a remarkably uniform story. Equally important, the analysis found no significant increase in functional deterioration between stroke episodes, with a pooled odds ratio of 1.28 (95% CI 0.75–2.19; I² = 0%). In other words, patients did not systematically worsen after their second stroke, and there was no signal that the repeat treatment itself drove neurological decline.

Perhaps the most clinically useful aspect of the analysis is what it ruled out. The researchers tested whether outcomes were influenced by the interval between treatments, patient age, sex, stroke etiology, vascular territory, or the time from symptom onset to treatment — and found that none of these factors significantly shaped results. This null finding directly undermines the logic of a fixed temporal cutoff. If the safety of a second dose does not measurably depend on how many days have elapsed since the first stroke, then a rigid three-month clock may be the wrong instrument for judging risk. Instead, the data suggest clinicians should weigh the individual biology of each recurrence rather than the calendar.

The safety signal was not entirely clean, and the authors are careful to report it. Asymptomatic intracranial or systemic hemorrhages occurred in 15.9 percent of patients — bleeding visible on imaging or detected clinically but not causing neurological worsening. Fatal events occurred in 5 percent of cases, but crucially, these deaths were unrelated to neurological complications. Both hemorrhagic and fatal events clustered predominantly in patients with cardioembolic strokes and more severe initial presentations, hinting that the underlying mechanism of recurrence and stroke severity, rather than the repeat thrombolysis itself, may drive adverse outcomes. This pattern aligns with mechanistic reasoning: cardioembolic strokes, often arising from atrial fibrillation or cardiac thrombi, tend to be larger and more lethal, and patients with severe deficits have more tissue at risk regardless of treatment.

To understand why the three-month rule exists at all, one has to look back to the founding trials of stroke thrombolysis. The 1995 NINDS trial of tissue plasminogen activator, which established alteplase as standard care, excluded patients with recent stroke, and subsequent guidelines from the European Stroke Organisation and the American Heart Association/American Stroke Association carried the exclusion forward as a relative contraindication grounded largely in expert consensus rather than dedicated trials of repeat dosing. The biological rationale — that freshly infarcted brain and reperfused vessels are more prone to bleeding — has never been disproven, but it has also never been rigorously quantified in the recurrent-stroke setting. Meanwhile, the clinical dilemma is real and growing: patients with active sources of embolism, unstable atherosclerotic plaques, carotid webs, free-floating thrombi, or basilar artery occlusions can suffer devastating recurrent strokes days or weeks after a first event, and withholding thrombolysis from them may condemn them to disability or death.

The new analysis, registered prospectively in PROSPERO (CRD420251276423) and conducted according to PRISMA 2020 reporting standards, synthesizes a literature that spans two decades of case reports and small series — from early accounts of imaging-guided repeat dosing in 2005 to multicenter case studies of ultra-early re-treatment published in 2023. The authors used the Heidelberg bleeding classification to standardize hemorrhage assessment and performed the meta-analysis with established statistical tooling. By extracting individual patient data wherever possible, they converted a scattered, anecdotal literature into something approaching coherent evidence — a methodological upgrade that previous systematic reviews of the same question, which relied on aggregated study-level data, could not achieve.

The caveats are substantial and the authors acknowledge them plainly. Repeated thrombolysis within 90 days is a rare event, and its efficacy remains understudied; the 63 patients analyzed come from published reports that are inherently subject to publication bias, since dramatic successes and instructive failures are more likely to reach print than unremarkable outcomes. There are no randomized trials, no matched controls who were denied repeat thrombolysis, and no way to fully separate the effect of treatment from the effect of careful patient selection — the very clinicians who chose to re-treat these patients presumably judged them to be favorable candidates. The favorable outcomes observed may partly reflect that selection rather than the safety of the drug itself. Five percent mortality, even if neurologically unrelated, is not negligible in an already fragile population.

Still, the conclusion the authors draw is measured and potentially practice-changing: repeated intravenous thrombolysis within 90 days may be a reasonable reperfusion strategy in carefully selected patients with recurrent acute ischemic stroke, and the interval from the previous stroke should not be treated as an isolated exclusion criterion. In an era when mechanical thrombectomy is increasingly available but not always feasible — particularly for distal vessel occlusions or in centers without endovascular capability — the finding suggests that the pharmacological route should not be automatically closed by the calendar. The evidence is observational and thin, but for a rule that has governed stroke units worldwide on the strength of consensus alone, the burden of proof may now have shifted. Larger, prospective registries of recurrent stroke treatment will be needed to confirm whether the zero-sICH finding holds at scale, but for clinicians facing a deteriorating patient with a fresh recurrence, this analysis offers something they have rarely had: data suggesting that saying yes to a second dose may not be the reckless act the guidelines have long implied.

Subject of Research: Safety and efficacy of repeated intravenous thrombolysis within three months for recurrent acute ischemic stroke

Article Title: Safety and efficacy of repeated intravenous thrombolysis within 3 months for acute ischemic stroke: a systematic review and individual-patient data meta-analysis

Article References: Scala, I., Ciacciarelli, A., Cancelloni, V., Digiovanni, A., Galotto, D., Gardin, A., Giammello, F., & the Italian Stroke Association (ISA)-Young (2026). Safety and efficacy of repeated intravenous thrombolysis within 3 months for acute ischemic stroke: a systematic review and individual-patient data meta-analysis. Journal of Neurology, 273(10), Article 607. https://doi.org/10.1007/s00415-026-14144-x

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DOI: 10.1007/s00415-026-14144-x

Keywords: stroke, intravenous thrombolysis, recurrent stroke, alteplase, symptomatic intracranial hemorrhage, meta-analysis, systematic review, cerebrovascular disease, reperfusion therapy, stroke guidelines, neurology, thrombolytic drugs

Mechanical thrombectomy, in which physicians thread catheters through blood vessels to physically remove a clot, is the established standard of care for acute ischemic stroke caused by a large vessel occlusion. Intravenous thrombolysis with the drug alteplase is recommended as first-line therapy within four and a half hours of symptom onset, and beyond that window when perfusion imaging shows salvageable brain tissue. When both treatments are used, the combination is known as bridging therapy. Yet the practice remains debated, because intravenous thrombolysis carries a risk of hemorrhage, and well-designed trials comparing direct thrombectomy with bridging therapy have produced mixed results. A recent Cochrane systematic review pooling six randomized controlled trials found no evidence of a difference in functional outcome, mortality, or intracranial hemorrhage between the two strategies, and its authors called for research into time- and person-specific factors that might determine who benefits from the intravenous drug.

Researchers at University Hospital Carl Gustav Carus in Dresden suspected that one such factor might be the biological composition of the clot itself. Clots removed from patients with large vessel occlusion vary considerably in their proportions of fibrin and red blood cells, and these differences fall largely along etiological lines. Clots of cardiac origin, which form when the heart’s rhythm falters and debris travels to the brain, tend to be rich in fibrin and platelets. Clots arising from atherosclerotic disease in the neck or brain arteries tend to be red blood cell rich. Fibrin-rich clots are denser, create more friction against vessel walls, and are known to be less sensitive to thrombolytic drugs, which work by infiltrating the clot and thinning its fibrin fibers. Red blood cell rich clots, with their more loosely packed fibrin networks, allow greater drug penetration and dissolve more readily.

To test whether these biological differences translate into different treatment outcomes, the team conducted a post hoc analysis of their prospective registry of consecutive thrombectomy patients treated between January 2017 and January 2023. The cohort included 798 adults who underwent thrombectomy for anterior circulation large vessel occlusion, either at the Dresden center directly or after transfer from one of thirteen telestroke network spokes or eight partner primary stroke centers in eastern Saxony. Just over half the patients were women, the median age was 77 years, and the median baseline stroke severity on the National Institutes of Health Stroke Scale was 15. Nearly half of the patients, 395 in total, received intravenous alteplase before thrombectomy; no other thrombolytic agents were used during the study period. Stroke etiology was classified according to the TOAST criteria by senior stroke consultants and validated through a secondary central review of all medical records.

The primary outcome was the time from groin puncture to successful angiographic reperfusion, quantified using the modified Thrombolysis in Cerebral Infarction score, with successful reperfusion defined as a score of 2b or higher. The researchers used stratified Cox proportional hazards regression, adjusting for age, baseline stroke severity, tandem occlusions, carotid T occlusions, occlusion site, and distal thrombus migration—a shift of the clot from a proximal to a more distal arterial segment that occurred before any endovascular maneuver. Overall, successful reperfusion was achieved in 85.2 percent of patients, and cardioembolic stroke accounted for 58.9 percent of cases.

The results split cleanly along etiological lines. Among the 330 patients with non-cardioembolic stroke, bridging intravenous thrombolysis was independently associated with a roughly 40 percent higher hazard of achieving successful reperfusion at any point during the procedure, with an adjusted hazard ratio of 1.40. This effect grew stronger in sensitivity analyses: when patients with stroke of undetermined etiology were excluded, the adjusted hazard ratio rose to 2.06, and a sub-analysis restricted to patients with large artery atherosclerotic stroke reproduced the benefit. Consistent with this, patients with atherosclerotic stroke who received the intravenous drug required about 36 percent fewer aspiration attempts during thrombectomy, an effect measured with a negative binomial regression that accounted for age, initial CT severity score, and occlusion site.

Among the 468 patients with cardioembolic stroke, however, the picture was entirely different. Intravenous thrombolysis alone showed no measurable effect on time to reperfusion, with an adjusted hazard ratio of 1.13 that did not reach statistical significance. More troubling, when the clot migrated distally after thrombolysis and before the procedure—a phenomenon observed in 9.7 percent of cardioembolic patients who received the drug versus 0.8 percent of those who did not—the likelihood of successful reperfusion at any given time point dropped by approximately 43 percent, with an adjusted hazard ratio of 0.57. The researchers propose that when thrombolysis fails to soften a fibrin-rich cardiac clot, it may instead promote its displacement into smaller, more distal arterial segments where thrombectomy is technically harder and less effective, a concern underscored by two recent negative randomized trials of thrombectomy for distal vessel occlusions.

The study also quantified the clinical stakes of procedural speed. Each additional 10 minutes of groin-to-recanalization time increased the odds of a worse functional outcome on the modified Rankin scale at 90 days by 8.6 percent, an association that remained robust after adjustment for patient characteristics, stroke features, interventional parameters, and metabolic markers. In other words, a treatment that accelerates reperfusion in one stroke subtype and delays it in another could meaningfully shift outcomes for individual patients, even if population-level averages obscure the difference.

The mechanistic story fits a growing body of evidence. Analyses of the MR CLEAN Registry biobank and other prospective thrombus studies have shown that cardioembolic clots contain a higher proportion of fibrin and platelets, while atherosclerotic clots are predominantly red blood cell rich. Fibrin-rich thrombi demand more recanalization attempts and yield lower reperfusion rates, and laboratory work suggests they are less susceptible to thrombolytic agents because their fibrin is densely packed. The multicenter RESTORE Registry found that clots retrieved in earlier thrombectomy passes had higher red blood cell content, while later passes yielded fibrin-rich material. Beyond simple histology, molecular analyses have identified neutrophil extracellular traps as structural components that stabilize the fibrin network and may contribute to thrombolysis resistance—raising the possibility that partial clot destabilization without effective lysis could promote distal embolization and increase procedural complexity.

The Dresden team is careful to note the limitations of their work. The data come from a regional network registry, histological characterization of retrieved clots was not available, and the subgroup of cardioembolic patients with distal thrombus migration was small, leaving room for residual confounding despite robust statistical adjustment. Cryptogenic stroke, moreover, is a highly heterogeneous category that may mask diverse underlying mechanisms. Still, the consistency of the etiological differences across all multivariable models, and their reproduction in the atherosclerotic sub-analysis, suggest a robust finding. If confirmed in larger studies, the results could help clinicians move beyond a one-size-fits-all approach to bridging therapy, reserving intravenous thrombolysis for the patients whose clots are most likely to yield to it—and sparing others a treatment that may do more harm than good.

Subject of Research: Effect of intravenous thrombolysis before thrombectomy on reperfusion outcomes in cardioembolic versus non-cardioembolic acute ischemic stroke

Article Title: IV Thrombolysis Facilitates Interventional Reperfusion in Non‐Cardioembolic but Not Cardioembolic Stroke

Article References: Sedghi, A., Kaiser, D. P. O., Arndt, M., Diel, N. J., Simon, E., Polanski, W. H., Puetz, V., Huttner, H. B., & Siepmann, T. (2026). IV Thrombolysis Facilitates Interventional Reperfusion in Non‐Cardioembolic but Not Cardioembolic Stroke. Annals of Clinical and Translational Neurology, 13(9), 1893-1902. https://doi.org/10.1002/acn3.70370

Image Credits: AI Generated

DOI: 10.1002/acn3.70370

Keywords: stroke, thrombectomy, intravenous thrombolysis, large vessel occlusion, cardioembolic stroke, clot composition, reperfusion, alteplase, TOAST classification, distal thrombus migration, fibrin-rich thrombi, bridging therapy