Alteplase Treatment Enhances Functional Independence in Posterior Circulation Stroke Patients

Recent research highlights the benefits of alteplase for patients experiencing mild posterior circulation ischemic strokes, particularly those who do not undergo thrombectomy. The study, published in the New England Journal of Medicine, indicates that administering alteplase between 4.5 to 24 hours after symptom onset significantly improves the likelihood of achieving functional independence at 90 days compared to standard medical care.

The investigation was conducted by a team from the Second Affiliated Hospital of Zhejiang University in Hangzhou, China. In this study, 234 patients were randomly assigned to receive either alteplase (at a dosage of 0.9 mg/kg of body weight, up to a maximum of 90 mg) or conventional medical treatment within the specified timeframe. The primary measure of effectiveness was the level of functional independence, determined by scores on the modified Rankin scale, which ranges from 0 (no symptoms) to 6 (death).

The results revealed that 89.6% of patients treated with alteplase achieved functional independence at the 90-day mark, compared to only 72.6% in the standard treatment cohort. The adjusted risk ratio for achieving this positive outcome was 1.16, indicating a notable advantage for those receiving alteplase.

Moreover, the occurrence of symptomatic intracranial hemorrhage within 36 hours was relatively low, reported at 1.7% for the alteplase group and 0.9% for those receiving standard treatment. Additionally, mortality rates at 90 days were recorded at 5.2% for patients treated with alteplase, in contrast to 8.5% for the standard treatment group.

The authors of the study emphasized that these findings support the use of alteplase within this extended time frame, particularly in cases where endovascular thrombectomy is not an option. This evidence is crucial for medical professionals when considering treatment protocols for posterior circulation strokes, potentially guiding future clinical practices.