Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site.

BACKGROUND: Because of the limitation of on-site neurology workforce, telestroke was implemented to overcome this barrier. We explored the efficacy and safety of intravenous (IV) stroke thrombolysis service by telestroke when neurologist was not available on-site. METHODS: From January 2009 to December 2012, we compared patients treated with IV stroke thrombolysis by telestroke in the form of telephone consultation with teleradiology, to patients treated after in-person assessment by the same team of neurologists in a regional hospital. Door-to-needle time, symptomatic intracranial hemorrhage, and functional outcome at 3 months were prospectively collected and compared between the groups. RESULTS: In all, 152 patients were treated with IV thrombolysis; 102 patients were treated with neurologist on-site; whereas 50 patients were treated by internists with telestroke. Fifty-two percent of the telemedical group achieved excellent outcome compared to 43% of the neurologist on-site group (P = .30). Symptomatic intracranial hemorrhage rate (4.0% versus 4.9%, P = 1.0) and mortality (8.3% versus 11.9%, P = .49) were comparable. Using the multiple logistic regression analysis, age, baseline stroke severity, and extent of early ischemic change on brain computed tomography scan, are independent predictors for excellent outcome, whereas the presence of neurologist on-site is not correlated with the outcome. CONCLUSIONS: Patients treated without neurologist on-site achieved similar outcome. Telephone consultation and teleradiology-guided IV stroke thrombolysis, with the support of on-site internist appeared safe and efficacious.

Safety and efficacy comparison of Tenecteplase and Alteplase for clinically suspected large vessel occlusion strokes without thrombectomy.

INTRODUCTION: Tenecteplase is a thrombolytic with higher fibrin affinity, and is potentially better in clot lysis. A higher spontaneous recanalization rate for large vessel occlusions strokes (LVO) had been shown in comparison studies with Alteplase. Results of the LVO studies reflect the composite effect of the thrombolytic and thrombectomy, as patients would be treated by thrombectomy had they not been recanalized by intravenous thrombolysis alone. Thrombectomy is not readily available in many parts of the world. Our study aimed to compare the outcomes of suspected LVO patients treated with Tenecteplase versus Alteplase only, without the confounding effect of thrombectomy. METHODS: This is a retrospective review. Data of patients given Tenecteplase from May 2020 to August 2023, and those given Alteplase 0.9 mg/kg from January 2019 to August 2023 were retrieved. (Due to fluctuation in supply of Tenecteplase during the COVID pandemic, some large vessel occlusion patients were given Alteplase.) Patients with anterior circulation, clinically suspected large vessel occlusion strokes (defined as National Institutes Health Stroke Scale (NIHSS) score >= 6, plus cortical signs or hyperdense vessel sign), with thrombolysis given within 4.5 hours of stroke onset were analyzed. Patients with thrombectomy done were excluded. Safety and efficacy outcomes were compared. RESULTS: There were 245 Tenecteplase treated patients treated between 1st May 2020 and 31st August 2023, and 732 patients were treated with Alteplase between 1st January 2019 to 31st August 2023. Out of these, 148 Tenecteplase patients and 138 Alteplase 0.9 mg/kg patients fulfilled the study criteria. The symptomatic intracerebral haemorrhage rate was non-significantly lower in the Tenecteplase group (2.1% versus 5.8%, p=0.13). There were no significant differences in the rate of >=8 points NIHSS improvement (23.6% versus 23.7%, p=1) or the >= 4 points improvement (40.5% versus 40.7%, p=1) at 24 hours. At 3 months, 21.6% of Tenecteplase patients had good functional outcome (modified Rankin scale (mRS) 0-2), compared to 26.3% in the Alteplase group (p=0.40). CONCLUSION: In this pragmatic study of clinically suspected anterior circulation LVO patients without thrombectomy, outcome solely reflects the effects of Tenecteplase. Tenecteplase showed comparable safety and efficacy to Alteplase. But the result should be interpreted with caution in view of its small sample size and non-randomized study design.

Risk factors for delayed-onset dementia after stroke or transient ischemic attack-A five-year longitudinal cohort study.

BACKGROUND: Stroke not only substantially increases the risk of incident dementia early after stroke but also the risk remains elevated years after. AIM: We aimed to determine the risk factors of dementia onset more than three to six months after stroke or transient ischemic attack. METHODS: This is a single-center prospective cohort study. We recruited consecutive subjects with stroke/transient ischemic attack without early-onset dementia. We conducted an annual neuropsychological assessment for five years. We investigated the association between baseline demographic, clinical, genetic (APOEɛ4 allele), and radiological factors as well as incident recurrent stroke with delayed-onset dementia using Cox proportional hazards models. RESULTS: In total, 1007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. Forty-nine (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥3 lacunes, history of ischemic heart disease, history of ischemic stroke, and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score were significantly associated with delayed-onset dementia. APOEɛ4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. CONCLUSION: The presence of ≥3 lacunes, history of ischemic heart disease, history of ischemic stroke, and a lower baseline MoCA score are associated with delayed-onset dementia after stroke/transient ischemic attack.