Thrombolysis before thrombectomy may help only the larger infarcts

The edition in brief

In a post hoc analysis of BRIDGE-TNK, 550 patients with large-vessel occlusion within 4.5 hours were stratified by baseline ASPECTS. Functional independence at 90 days favoured tenecteplase before thrombectomy in those with ASPECTS under 8 (adjusted risk ratio 1.67, 95% CI 1.18 to 2.35) but not in those with ASPECTS 8 to 10 (1.00, 0.84 to 1.17; interaction p = 0.007). Symptomatic intracranial haemorrhage did not differ significantly, but 90-day mortality was numerically higher with tenecteplase in the ASPECTS 8 to 10 group (aRR 1.89, 0.99 to 3.61; interaction p = 0.04). The authors call for prospective confirmation before practice change. A secondary analysis of TEMPO-2 divided 881 patients with minor stroke by baseline occlusion status. No subgroup showed benefit from tenecteplase: adjusted risk ratios were 1.03 for no visible occlusion, 0.85 for near occlusion and 1.00 for complete occlusion. A single-centre randomised trial of onabotulinumtoxinA in 33 patients with painful foot dystonia in Parkinson disease found a mean difference of −3.60 on King's Parkinson's Disease Pain Scale item 5 at six weeks, Hedges' g −1.33, with 75.0% reaching a 30% pain reduction against 11.8% on placebo, and no effect on motor scores. An updated Cochrane review of 53 trials found cardiorespiratory training after stroke does not change mortality or secondary events, with uncertain gains in fitness and walking speed. In 329 patients with relapsing multiple sclerosis, failure to reduce neurofilament light z-score over a year tripled the odds of later disease activity.