Intravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.

Purpose: Outcome after ischaemic stroke (AIS) depends on multiple factors, including values of blood pressure (BP) and arterial stiffness (AS) in the early phase. It is also known that stroke outcome is affected by BP variability; however, the influence of AS oscillations in the early phase of stroke on its prognosis is unknown. The aim of our study was to assess the relationship between changes of AS markers and stroke outcome. Materials and methods: Baseline clinical data, BP parameters, and markers of AS (pulse wave velocity [PWV], augmentation index [AIx]) were assessed 1, 6, and >90 days after AIS. The outcomes were defined using modified Rankin scale (mRS) score: early favourable (EFO) and early poor (EPO), as mRS ≤1 and >2 points at discharge, respectively; late favourable (LFO) and late poor (LPO), as mRS ≤1 and >2 points on day >90, respectively. Results: In the recruited 50 patients (62.2 ± 12.1 years, 68% males), BP and PWV decreased while AIx did not change within 90 days after AIS. Twenty-eight patients (56%) had EFO, 10 (20%) – EPO, 29 (58%) – LFO, and 9 (18%) – LPO. In univariate analysis, rise in AIx in days 1–6 was associated with EFO (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.02–1.17, p = 0.01) and LFO (OR = 1.08; 95%CI = 1.01–1.14, p = 0.02), whereas decrease in AIx in days 1–6 was associated with EPO (OR = 1.07, 95%CI = 1.00–1.15, p = 0.05). For EFO and LFO, the relationships remained significant after including confounders (p = 0.03 and p = 0.03, respectively). Conclusions: Rise in AIx within one week after ischaemic stroke may be of additional importance in determining better early and late favourable functional outcome.

Stroke is the second most common cause of death. Although one of the most important stroke causes is hypertension, the prognostic value of blood pressure (BP) variability in stroke victims remains inconsistent. The aim of the study was to assess the relationship between blood pressure variability and functional outcome after ischemic stroke. We analysed 94 patients with acute ischemic stroke admitted to the Department of Adult Neurology, Medical University of Gdansk, Poland. Ambulatory blood pressure monitoring (ABPM) was performed one week after stroke. ABPM-based coefficients of variation (CV, standard deviation/mean x100) for systolic (SBP), mean (MBP), and diastolic (DBP) BP were calculated. Short-term functional outcome was evaluated at day 7 with modified Rankin Scale (mRS) score of 0 to 1 defined as excellent outcome. BP variables were compared between excellent and non-excellent groups; possible co-founders were included in multivariate logistic regression. The mean patient age was 68.0 (±12.4) years. In univariate analysis, CVs for DBP and MBP were higher in the excellent group (13.5 vs. 12.2, p = 0.02; 11.6 vs. 10.4, p = 0.01; respectively; Table 1). In multivariate logistic regression, after adjustment for age, sex, National Institutes of Health stroke scale (NIHSS) score, previous stroke, and tissue plasminogen activator administration (tPA), the relationship remained statistically significant (Tables 2 and 3). Blood pressure variability measured as CVs for DBP or MBP was associated with early functional outcome after ischemic stroke independently of classical predictors.

Background/Objectives: Acute ischemic stroke (AIS) associated with cervical carotid artery pathology remains a therapeutic challenge due to uncertainty regarding emergent carotid artery stenting (eCAS) and the need for intensified antithrombotic therapy, which may increase the risk of hemorrhagic transformation (HT). This retrospective cohort study evaluated the functional and safety outcomes of eCAS within an extended treatment time window. Methods: We analyzed 139 consecutive patients with anterior circulation AIS and large vessel occlusion treated with mechanical thrombectomy between 2019 and 2024. Patients were eligible for MT within 24 h based on clinical–core mismatch (DAWN) or perfusion–core mismatch (DEFUSE 3) criteria. Outcomes were compared between patients treated with eCAS and those undergoing MT without stenting. Results: Twenty-five patients underwent eCAS, predominantly for tandem lesions (80%). Median age was 66 years, median baseline NIHSS was 14, and median infarct core volume on DWI/CTP was 15 mL. Baseline characteristics were comparable between groups, except for the site of occlusion (p < 0.001). A good functional outcome (modified Rankin Scale, mRS 0–2 at 90 days) was observed in 60% of patients in the eCAS group versus 43% in the non-stenting group, without statistical significance (p = 0.067). Rates of parenchymal hematoma (12% vs. 18.4%) and symptomatic intracerebral hemorrhage (8% vs. 3.5%) were similar between groups. Conclusions: In this single-center cohort, eCAS performed in an extended time window did not demonstrate a clear signal of increased hemorrhagic risk. However, residual confounding and imbalance between treatment groups persisted despite the application of inverse probability weighting (IPW), and the findings should be interpreted cautiously.

Background: Evidence supporting mechanical thrombectomy (MT) in very elderly patients remains limited, as nonagenarians are underrepresented in randomized trials and frequently excluded from MT in routine practice. We evaluated the effectiveness and safety of MT in carefully selected patients aged ≥ 90 years treated at a comprehensive stroke center. Methods: We conducted a retrospective single-center cohort study including consecutive patients with anterior circulation large vessel occlusion treated with MT. Fifty nonagenarians treated between 2017 and 2025 were compared with 100 younger patients treated in 2023. In both groups, only patients with preserved pre-stroke functional independence (modified Rankin Scale [mRS] 0–2) were included. Nonagenarians underwent detailed pre-treatment clinical assessment prior to treatment. Primary outcomes were functional independence (mRS 0–2) and all-cause mortality at 90 days. Secondary outcomes included successful reperfusion (mTICI 2b–3), neurological status at discharge, and hemorrhagic complications. Multivariable regression models were used to adjust for baseline imbalances and clinically relevant prognostic factors. Results: Nonagenarians had a substantially higher burden of comorbidities and worse pre-stroke functional status than younger patients. Successful reperfusion rates were similar between groups (92% vs. 90%). Functional independence at 90 days was achieved in 18% of nonagenarians and 50% of younger patients, while 90-day mortality was 52% and 20%, respectively. In unadjusted analyses, nonagenarians had lower odds of functional independence and higher odds of mortality. After adjustment for baseline clinical and prognostic factors, the estimated associations were attenuated, although confidence intervals remained wide and the study could not exclude a clinically relevant age-associated effect. Parenchymal hematoma occurred more frequently among nonagenarians, whereas rates of symptomatic intracerebral hemorrhage were comparable between groups. Conclusions: In this highly selected real-world cohort, MT achieved high rates of successful reperfusion in nonagenarians, but functional outcomes and mortality were substantially less favorable than in younger patients. Adjustment for baseline clinical and prognostic factors attenuated the estimated associations, although clinically relevant age-associated differences could not be excluded. These findings support cautious, individualized treatment decisions incorporating chronological age, pre-stroke function, comorbidity burden, imaging findings, and the overall clinical profile.