Deans' stroke musings: Efficacy and safety of intravenous tenecteplase thrombolysis in diffusion-weighted imaging-negative posterior circulation ischemic stroke

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.

Monday, October 27, 2025

Efficacy and safety of intravenous tenecteplase thrombolysis in diffusion-weighted imaging-negative posterior circulation ischemic stroke

Since you didn't write a protocol on this; YOU'RE FIRED! Stroke research is to get survivors recovered, not just get you published!

Efficacy and safety of intravenous tenecteplase thrombolysis in diffusion-weighted imaging-negative posterior circulation ischemic stroke

Ying Zhang

Shengqi Fu^*

Shengjie Hu

Lili Zhu

Jiarong Li

Baoyang Shi

Liang Song

Dongdong Yang

Department of Neurology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People’s Hospital), Zhengzhou, China

Introduction: Clear evidence supporting thrombolytic therapy in diffusion-weighted imaging (DWI)-negative posterior circulation ischemic stroke (PCIS) is lacking. We aimed to investigate the efficacy and safety of intravenous thrombolysis using tenecteplase (TNK) for the treatment of DWI-negative PCIS.

Method: A retrospective analysis was conducted on 310 patients with DWI-negative PCIS (TNK group, 100 patients; control group, 210 patients) with propensity score matching (PSM, 63 pairs). Efficacy was assessed using the 90-day modified Rankin Scale (mRS) score and early neurological deterioration (END); safety was evaluated by mortality and symptomatic intracerebral hemorrhage (sICH).

Results: The PSM-matched cohort comprised 126 patients (67 men), with a mean age of 68.9 ± 7.9 years. After PSM matching, the 24 h National Institutes of Health Stroke Scale (NIHSS) scores of the two patient groups [3.0 (3.0, 5.0) vs. 4.0 (3.0, 6.0) points] and the NIHSS scores at discharge [2.0 (1.0, 3.0) vs. 3.0 (2.0, 4.0) points] (p < 0.05) were compared. In the PSM-matched TNK group, the 90-day 0–1 mRS score (85.7% vs. 58.7%, p = 0.028) and END rate (1.6% vs. 19.0%, p = 0.011) were significantly better than those of the control group with no increased mortality or sICH. However, the control group had a 90-day mortality rate of 3.2% (2/63; both patients died of stroke-induced pulmonary infections).

Conclusion: In patients with DWI-negative PCIS, TNK increased the proportion of patients achieving a mRS score of 0–1, reduced the incidence of END, improved long-term prognosis, and demonstrated a favorable safety profile; in contrast, the control group exhibited a higher incidence of END and poorer overall prognosis. Notably, this study has limitations, including its single-center retrospective design and small sample size after PSM, which may restrict the generalizability of the present findings.