1. Intravenous thrombolysis for ischemic stroke in the posterior circulation : a systematic review and meta-analysisRobrecht R. M. M. Knapen, Senta Frol, Sander M.J. van Kuijk, Janja Pretnar-Oblak, Christiaan van der Leij, Robert J. van Oostenbrugge, Wim H. van Zwam, 2024, izvirni znanstveni članek Ključne besede: Intravenous thrombolysis, ischemic stroke, posterior circulation
Objavljeno v DiRROS: 12.06.2026; Ogledov: 95; Prenosov: 223
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2. Revisiting antiplatelet therapy in acute carotid tandem lesionsMatija Zupan, Lara Straus, Pawel Kermer, Panagiotis Papanagiotou, Senta Frol, 2026, pregledni znanstveni članek Povzetek: Background/Objectives: Acute carotid tandem lesions (TLs), defined by concurrent cervical internal carotid artery (ICA) stenosis or occlusion and intracranial large vessel occlusion, occur in 10–20% of patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Optimal periprocedural antiplatelet management during emergent carotid artery stenting (eCAS) remains uncertain, particularly regarding the balance between preventing stent thrombosis and avoiding hemorrhagic complications. Methods: A narrative review was conducted using PubMed and Scopus (until 6 March 2026) to identify English-language studies evaluating antiplatelet therapies during eCAS for TLs. We included seven real-world studies and registry analyses. Data on study design, patient characteristics, procedural strategies, angiographic results, functional outcomes, and safety metrics were extracted. Results: No randomized controlled trials (RCTs) were identified. The available evidence is derived exclusively from observational studies. Across these cohorts, glycoprotein IIb/IIIa inhibitors (GPIs), particularly tirofiban, were generally associated with lower rates of in-stent thrombosis and higher reperfusion success, with symptomatic intracranial hemorrhage (sICH) rates that appeared comparable to or lower than those reported with acetylsalicylic acid (ASA). Cangrelor, an intravenous (IV) P2Y12 inhibitor, was associated with improved stent patency and increased likelihood of complete reperfusion, although reported effects on clinical outcomes were inconsistent when compared with GPIs or ASA. Aside from abciximab, potent IV antiplatelet agents did not consistently show an increased sICH signal. Oral dual antiplatelet therapy was also associated with improved technical outcomes without a clear excess in bleeding complications. Conclusions: Current real-world observational data suggest that rapid-acting IV antiplatelet agents—particularly GPIs and, increasingly, cangrelor—may represent feasible periprocedural options during eCAS for TLs, with potential benefits for technical success and no consistent evidence of increased hemorrhagic risk. However, interpretation is limited by study heterogeneity and non-randomized designs. The absence of RCTs highlights the need for prospective comparative studies and standardized periprocedural antiplatelet protocols.
Ključne besede: acute carotid tandem lesions, acute ischemic stroke, antiplatelet therapy, cangrelor, glycoprotein IIb/IIIa inhibitors
Objavljeno v DiRROS: 23.04.2026; Ogledov: 184; Prenosov: 122
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3. Automated assessment of collateral circulation and infarct core : predictors of functional outcomes in acute ischemic stroke following endovascular thrombectomyIngrid Požar, Fajko Bajrović, Lan Umek, Katarina Šurlan Popović, 2025, izvirni znanstveni članek Povzetek: Purpose: This study aimed to evaluate the predictive value of automatically assessed collateral circulation (CC) and infarct core for functional outcome in acute ischemic stroke (AIS) patients treated with endovascular thrombectomy (EVT). Methods: We conducted a retrospective cohort study of 208 patients with anterior large vessel occlusion treated with EVT. Two AI-powered software were used to automatically assess CC and infarct core. Comparative analyses included patient demographics, clinical and imaging data, and functional outcome. Univariate and multivariable logistic regression analyses were conducted to predict the 90-day functional outcome. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2. Results: Among the 208 patients, 114 (54.8%) were women and 94 were men, with a mean age of 71.4 ± 13.3 years. Patients with higher collateral score (CS) exhibited lower infarct core volumes (p < 0.001) and better mRS score at 90 days (p = 0.008). Among patients with a favorable outcome, the mean infarct core volume was lower compared to those with poor outcomes (5 mL vs. 8.6 mL, p = 0.003). In univariate logistic regression, both infarct core (OR 0.94, p = 0.005) and CS (OR 1.84, p = 0.014) were predictors of favorable outcome. However, in multivariable models, only infarct core remained a significant independent predictor [AORs of 0.95 (p = 0.021) and 0.96 (p = 0.039)]. Conclusion: Automatically assessed infarct core is a robust predictor of functional outcome in AIS patients post-EVT, while CS's predictive value diminishes when adjusted for infarct core. These findings support the integration of AI-powered evaluations in clinical settings to improve prognosis and treatment strategies for AIS.
Ključne besede: acute ischemic stroke, CT angiography, CT perfusion, collorectal circulation, infarct core
Objavljeno v DiRROS: 16.04.2026; Ogledov: 201; Prenosov: 187
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4. Letter to the editor regarding "Safety of tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke patients with direct oral anticoagulation: experience from a German stroke center" by Mers et al.Matija Zupan, Pawel Kermer, Senta Frol, 2026, drugi znanstveni članki Ključne besede: intravenous thrombolysis, tenecteplase, alteplase, acute ischemic stroke, direct oral anticoagulant intake, DOAC
Objavljeno v DiRROS: 23.03.2026; Ogledov: 330; Prenosov: 178
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5. Tenecteplase - what have we learned till now? : a narrative reviewMatija Zupan, Lara Straus, Pawel Kermer, Senta Frol, 2025, izvirni znanstveni članek Povzetek: Tenecteplase (TNK), a genetically modified tissue plasminogen activator, has emerged as a promising alternative to alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Our aim was to synthesize the current clinical evidence on TNK use in AIS patients, comparing efficacy, safety, and workflow benefits to ALT. A narrative review was conducted by searching PubMed and Scopus (January 2024–March 2025) for studies comparing TNK and ALT in AIS. A total of 35 eligible papers were included. Data were grouped by treatment scenario: IVT-only, bridging before endovascular therapy (EVT), and intra-arterial thrombolysis (IAT). The results showed that TNK is non-inferior— and in some analyses, superior—to ALT regarding functional outcomes, especially in large vessel occlusion. TNK facilitates shorter treatment delays due to its single-bolus administration. While some trials report higher rates of intracranial hemorrhage, overall safety and mortality are comparable. In conclusion, TNK appears to exert equivalent or superior efficacy and safety compared to ALT in multiple AIS scenarios. Its pharmacological and logistical advantages support its broader clinical adoption. Further trials are needed, especially for IAT, central retinal artery occlusion, and patients on dabigatran
Ključne besede: tenecteplase, acute ischemic stroke, treatment, narrative review, alteplase
Objavljeno v DiRROS: 23.02.2026; Ogledov: 473; Prenosov: 265
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6. Thrombus composition and the evolving role of tenecteplase in acute ischemic strokeSenta Frol, Matija Zupan, 2025, pregledni znanstveni članek Povzetek: Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy in large vessel occlusions (LVOs) or fibrin-rich clots. Tenecteplase (TNK), a bioengineered thrombolytic agent with superior pharmacokinetics, simplified administration, and higher fibrin specificity, offers promising advantages over rt-PA, including potential synergy with MT and efficacy against resistant thrombi. Direct oral anticoagulants (DOACs) further complicate AIS management, but evidence suggests that DOAC-treated patients may experience better thrombolysis outcomes due to distinct thrombus characteristics. Advances in imaging now enable precise visualization of vessel occlusion and treatment effects, opening opportunities to refine therapies. Combination approaches targeting fibrin thrombus components may enhance thrombolysis and improve outcomes in resistant cases. Future research should explore TNK’s role in intra-arterial (IA) applications, combination therapies, and its interaction with MT to optimize reperfusion strategies. TNK’s simplified use and promising efficacy position it as a potential breakthrough in AIS management, with the potential to improve functional recovery and reduce treatment complexity.
Ključne besede: thrombus, thrombolysis, tenecteplase, acute ischemic stroke, combination therapies
Objavljeno v DiRROS: 08.01.2026; Ogledov: 675; Prenosov: 288
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