Deans' stroke musings: Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, August 19, 2025

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

But you're not even measuring 100% recovery! HOW THE HELL WILL YOU EVER GET THERE, YOU BLITHERING IDIOTS!

“What's measured, improves.” So said management legend and author Peter F. Drucker

The latest here:

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

1. In this randomized controlled trial of patients with posterior circulation stroke not for thrombectomy, treatment with alteplase 4.5 to 24 hours after symptom onset increased the likelihood of functional independence by 90 days, compared to standard treatment.

2. The incidence of intracranial hemorrhage was higher with alteplase, but mortality at 90 days was higher with standard treatment, although neither reached statistical significance.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Intravenous thrombolysis (IVT) is the standard of care for ischemic stroke within 4.5 hours after symptom onset, especially if endovascular thrombectomy is unavailable. In patients with salvageable brain tissue, extending the IVT window up to 24 hours has been demonstrated as beneficial in patients with large-vessel occlusion of the anterior circulation. Posterior circulation strokes are difficult to diagnose, prone to delayed treatment, and with posterior circulation being less prone to hemorrhage from IVT, there is interest in extending the IVT window in this condition. This trial assessed IVT with alteplase in patients with posterior circulation ischemic stroke, without extensive early hypodensity on imaging, 4.5 to 24 hours after symptom onset. Compared to standard medical treatment, alteplase resulted in a higher percentage of functional independence by 90 days. Alteplase was associated with a higher rate of symptomatic intracranial hemorrhage within 36 hours, yet 90-day mortality was higher with standard treatment. These results were limited to patients with mild strokes for whom endovascular thrombectomy was not available, and the study was open-label. Notwithstanding, alteplase demonstrated clinical benefits when used in patients with posterior circulation ischemic stroke between 4.5 to 24 hours after onset.

Click here to read the study in NEJM