Neurology, distilled.

Test whether an integrative polygenic score (iPGS) for ischemic stroke can identify older adults who derive net benefit from low-dose aspirin for the primary prevention of ischemic stroke.

In the highest iPGS quintile (Q5), aspirin reduced ischemic stroke by 51% (HR 0.49 [95% CI, 0.28–0.85]; P=0.011) with no increase in major bleeding (HR 1.15 [0.71–1.88]).

Evaluate whether ultra-early remote ischemic postconditioning (RIPC) added to guideline-based therapy improves 90-day functional independence in patients with acute ischemic stroke (AIS) due to large vessel occlusion who underwent endovascular thrombectomy (EVT) with successful recanalization.

Primary outcome (mRS 0–2 at 90 days) not met: 60.9% RIPC vs 57.8% control (adjusted RR 1.07, 95% CI 0.89–1.30; P=0.46).

Test whether combining clopidogrel-aspirin dual antiplatelet therapy with immediate intensive statin further reduces 90-day new stroke risk in acute mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, using a 2x2 factorial design.

Combination of clopidogrel-aspirin + immediate intensive statin lowered 90-day new stroke vs aspirin + delayed statin: 7.6% vs 9.9% (HR 0.76, 95% CI 0.60-0.97; ARR 2.2%, NNT 45)

Test whether intensive blood pressure lowering (SBP <140 mm Hg) for 24 hours after successful endovascular thrombectomy in acute ischemic stroke has durable effects on functional outcome and mortality at 1 year, compared with conventional management (SBP 140–180 mm Hg).

Functional independence (mRS 0–2) at 1 year was lower with intensive vs conventional BP management: 40.5% vs 52.7% (ITT adj OR 0.59, 95% CI 0.34–1.00, P=0.051; per-protocol 41.1% vs 54.7%, adj OR 0.56, 95% CI 0.32–0.97, P=0.040)

Determine the safety and optimal dose of rapid local ischemic postconditioning (RL-IPostC) delivered via a balloon-guiding catheter immediately after successful mechanical thrombectomy in acute anterior-circulation large-vessel occlusion stroke.

The 2 min inflation / 2 min deflation × 4 cycles regimen met prespecified safety and efficacy thresholds and was selected as the optimal dose (posterior probability true toxicity >15% ≈ 0.16; efficacy <60% ≈ 0.15).

Assess whether baseline CT markers of cerebral small vessel disease (cSVD), as a surrogate for brain frailty, explain the reduced benefit of mechanical thrombectomy observed in elderly patients enrolled in the RESILIENT trial in Brazil.

Mechanical thrombectomy benefit was concentrated in patients <70 years with low cSVD burden (OR 4.16, 95% CI 1.6-10.4, p<0.01)

Assess the safety and efficacy of long-term antiplatelet treatment after spontaneous intracerebral hemorrhage (ICH) in patients with vascular disease.

Trial terminated early due to slow recruitment (69 of 500 planned patients enrolled).

In minor ischemic stroke (NIHSS 0–5) with proven intracranial occlusion enrolled in TEMPO-2, evaluate whether successful early recanalization on 4–8 hour follow-up CTA is associated with better 90-day functional outcomes, and identify predictors of successful recanalization.

Successful early recanalization (rAOL 2b/3) was independently associated with better 90-day functional outcome: 80.3% vs 66.4% return to baseline mRS (adjusted RR 1.21, 95% CI 1.09–1.34).