Neurology, distilled.

In patients with acute ischaemic stroke due to large vessel occlusion undergoing endovascular thrombectomy, does a single IV dose of nerinetide (2.6 mg/kg) improve 90-day functional outcomes compared with placebo.

Primary outcome (mRS 0–2 at 90 days) was not met: 337/549 (61.4%) nerinetide vs 329/556 (59.2%) placebo; adjusted RR 1.04 (95% CI 0.96–1.14), p=0.35.

Determine whether lying-flat vs sitting-up head positioning for 24 hours after acute stroke reduces 90-day disability.

No significant difference in 90-day disability distribution on modified Rankin scale: unadjusted OR 1.01 (95% CI 0.92–1.10), P=0.84.

Determine whether mechanical thrombectomy added to intravenous alteplase improves functional independence at 3 months in patients with acute ischaemic stroke and proximal anterior-circulation large-vessel occlusion.

Primary: mRS 0-2 at 3 months achieved by 106/200 (53%) with IVT+thrombectomy vs 85/202 (42%) with IVT alone (OR 1.55, 95% CI 1.05-2.30; p=0.028; NNT=9).

To compare medical management alone with medical management plus interventional therapy (neurosurgery, endovascular embolisation, and/or stereotactic radiotherapy) for preventing death or symptomatic stroke in adults with an unruptured brain arteriovenous malformation.

Medical management sharply reduced death/stroke vs interventional therapy: 11/109 (10.1%) vs 35/114 (30.7%); HR 0.27 (95% CI 0.14–0.54), p<0.0001 — trial halted early at 2nd interim.

Test whether early decompressive hemicraniectomy vs conservative ICU care improves survival without severe disability in patients ≥61 years with malignant middle-cerebral-artery infarction.

Primary: survival without severe disability (mRS 0-4) at 6 mo was 38% with hemicraniectomy vs 18% control (OR 2.91, 95% CI 1.06-7.49, P=0.04).

To determine whether intermittent pneumatic compression (IPC) reduces the risk of deep vein thrombosis (DVT) in immobile patients hospitalized with acute stroke.

IPC significantly reduced proximal DVT within 30 days: 8.5% vs 12.1% (adjusted OR 0.65, 95% CI 0.51–0.84, p=0.001; ARR 3.6%, 95% CI 1.4–5.8)

In patients with moderate-to-severe acute ischemic stroke treated with IV t-PA within 3 hours of onset, does adding endovascular therapy improve 90-day functional independence versus IV t-PA alone?

No difference in mRS 0-2 at 90 days: 40.8% endovascular+IV t-PA vs 38.7% IV t-PA alone; adjusted difference 1.5 pp (95% CI −6.1 to 9.1); trial stopped early for futility.

In patients <60 years with a patent foramen ovale and cryptogenic ischemic stroke, TIA, or peripheral thromboembolism, does percutaneous PFO closure with the Amplatzer PFO Occluder reduce recurrent embolic events or death compared with medical therapy alone?

Primary composite of death/stroke/TIA/peripheral embolism: 7/204 (3.4%) closure vs 11/210 (5.2%) medical therapy; HR 0.63 (95% CI 0.24-1.62), P=0.34 — not significant.