This Week in Neurology: Stroke Treatments and Alzheimer's Genetics

A recent JAMA trial ^[1] explored the use of intravenous tenecteplase for non-large vessel occlusion acute ischemic stroke within 4.5 to 24 hours of symptom onset. The study found that while tenecteplase increased the likelihood of excellent functional outcomes at 90 days, it also raised the risk of symptomatic intracranial hemorrhage within 36 hours. Clinicians will need to carefully weigh these benefits and risks when considering thrombolysis in this extended time window. Meanwhile, a separate study in the International Journal of Stroke ^[4] looked at the impact of influenza vaccination timing on acute coronary syndrome patients with prior stroke. While there was no difference in outcomes for those without prior stroke, the double-dose regimen administered in-hospital significantly reduced the hierarchical composite of death, myocardial infarction, stroke, and other cardiovascular events in patients with a history of stroke. This suggests that timing and dosing may be critical for high-risk subgroups, though further research is needed to confirm these findings.

Elsewhere this week, we saw research in The Journal of Prevention of Alzheimer's Disease ^[5] focusing on the genetic subgroup of ApoE4 non-carriers or heterozygotes with early Alzheimer's disease. A Phase 3 subgroup analysis found that lecanemab significantly reduced clinical decline compared to placebo at 18 months. However, these results are specific to this genetic subgroup and require cautious interpretation regarding broader applicability.