N Engl J Med

Alteplase boosts recovery in posterior circulation stroke

April 9, 2025

Alteplase administered within 4.5 to 24 hours of stroke onset significantly improved functional outcomes in patients with mild posterior circulation ischemic stroke, offering a viable treatment option beyond the conventional 4.5-hour window.

Study details: This multicenter, randomized controlled trial conducted in China evaluated the efficacy and safety of alteplase administered 4.5 to 24 hours after the onset of posterior circulation ischemic stroke. A total of 234 patients were enrolled, with 117 receiving alteplase and 117 receiving standard medical treatment. The primary outcome was functional independence at 90 days, defined as a modified Rankin scale (mRS) score of 0 to 2.

Results: In the alteplase group, 89.6% of patients achieved functional independence at 90 days, compared with 72.6% in the standard treatment group (adjusted risk ratio, 1.16; 95% confidence interval [CI], 1.03-1.30; P = 0.01). The incidence of symptomatic intracranial hemorrhage was slightly higher in the alteplase group (1.7% vs. 0.9%), but mortality rates were lower (5.2% vs. 8.5%).

Source:

Yan S, et al; EXPECTS Group. (2025, April 3). N Engl J Med. Alteplase for Posterior Circulation Ischemic Stroke at 4.5 to 24 Hours. https://pubmed.ncbi.nlm.nih.gov/40174223/