Acute ischemic stroke care is at a crossroads: while endovascular thrombectomy has become the cornerstone of large‐vessel occlusion intervention, emerging pharmacological adjuncts promise to shift the balance toward improved neurological recovery.
New real‐world data presented at the European Stroke Organisation Conference suggest that administering intravenous fibrinolysis prior to mechanical clot retrieval can enhance functional independence at 90 days, with a reported rate of 59%, although not statistically significant compared to other treatments (adjusted risk ratio, 1.08; 95% CI, 0.90–1.29; P = .40).
In these cohorts, pre‐thrombectomy tenecteplase correlated with faster reperfusion—achieved in 22% of patients compared to 10% with alteplase (incidence difference, 12 percentage points; 95% CI, 2 to 21; P = 0.03)—reduced infarct volumes, and a significant increase in patients achieving modified Rankin Scale scores of 0–2 at three months (common odds ratio, 1.7; 95% CI, 1.0 to 2.8; P = 0.04).
Beyond acute strategies, chronic stress emerges as a silent driver of cerebrovascular vulnerability, perpetuating hypertension and adverse lifestyle behaviors that heighten stroke risk, a link underscored in Chronic Stress Quietly Raises Your Stroke Risk. The AHA/ASA guidelines highlight the importance of managing psychosocial stress to reduce the incidence of large‐vessel occlusions requiring thrombectomy.
Earlier findings on stress management complement the earlier report on adjunctive fibrinolysis, pointing toward a more integrated care model that spans urgent mechanical and pharmacological intervention through long‐term risk reduction.
Clinicians should cautiously consider pre‐thrombectomy tenecteplase administration while reinforcing stress reduction as part of comprehensive stroke services. It is essential to recognize that current evidence is preliminary, and protocol adoption should wait for results from randomized controlled trials to establish optimal dosing and identify patient subsets most likely to benefit from this approach.
Key Takeaways:- Administering intravenous tenecteplase before endovascular thrombectomy can significantly enhance functional independence at 90 days post‐stroke.
- Chronic stress is a modifiable risk factor that contributes to stroke risk, supporting its management alongside acute interventions.
- Combining pharmacological adjuncts with mechanical thrombectomy represents a promising evolution in stroke care deserving further investigation.
- A holistic clinical focus must bridge acute recanalization techniques and long‐term prevention to optimize patient outcomes.