BackgroundDespite current guidelines recommending against intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with direct oral anticoagulants (DOAC) within prior 48 h, latest real-world data indicate no increased bleeding risk. However, these observations are based mainly on alteplase (rt-PA), whereas data for tenecteplase (TNK) are scarce.MethodsWe retrospectively compared data from our stroke registry of AIS-patients with DOAC (intake within the last 48 h), who received IVT either with rt-PA or TNK without prior antagonization. The primary outcome was the rate of symptomatic intracranial hemorrhage (sICH) per SITS-Most criteria. Secondary outcomes included the rate of any ICH or major bleeding, rate of mortality, neurological and functional outcome at discharge.Results82 AIS-patients were included, with 42 patients receiving TNK und 40 patients receiving rt-PA. Median age was 83 y for TNK patients and 82 y for rt-PA patients. Median NIHSS score at admission for TNK was 9 points for both groups (p = 0.61). Median drug-specific DOAC plasma level was 49 ng/mL for TNK versus 24 ng/mL for rt-PA (p = 0.04). We found no statistically significant increased risk for neither sICH (TNK 2.4% vs. rt-PA 2.5%; p = 1), nor for other safety outcomes for TNK-treated patients compared with rt-PA. The rate of excellent functional outcome (TNK 61.9% vs. rt-PA 52.5%) was similar among both groups. High drug-specific DOAC plasma levels were not related to an increased rate of hemorrhagic complications in our cohort.ConclusionWe report no increased rate of (s)ICH for TNK based IVT compared with rt-PA in AIS-patients with DOAC, indicating a similar safety profile. Moderate to high drug-specific DOAC levels were no surrogates for hemorrhagic complications, supporting the implementation of specific Standard Operating Procedures for IVT in DOAC-treated patients. Contrary to previous studies, we did not observe an increased rate of early recanalization of LVO in TNK-treated patients in this small single-center cohort.Trial registrationn/A.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42466-025-00450-8.

Kappa free light chains (KFLC), a byproduct of immunoglobulin (Ig) synthesis by B-lineage cells, can serve as an indicator for inflammatory activity. In multiple sclerosis (MS), especially the intrathecal KFLC production has gained increasing importance as a biomarker for central nervous system (CNS) inflammation and was included into the proposed 2024 revision of the McDonald criteria. In contrast, studies investigating the significance of KFLC in serum and the effects of disease-modifying therapies (DMT) on KFLC serum concentration in MS are rare. The aim of the present work was to investigate the impact of B cell depletion with ocrelizumab on KFLC concentrations in serum of MS patients and the ability of serum KFLC to monitor disease activity. 50 MS patients were included in the present study- 38 with the diagnosis of relapsing MS (RMS) and 12 with diagnosis of primary-progressive MS (PPMS) -, who were treated with ocrelizumab for two years. Serum concentrations of albumin, immunoglobulins and KFLC as well as lymphocyte subsets were determined at baseline and after two years. Serum Ig and KFLC concentrations were found to be significantly lower after two years of ocrelizumab treatment (mean serum concentrations: KFLC: 9.5mg/l vs. 7.8mg/l, p = 0.0003; IgG: 9g/l vs. 8g/l, p = 0.0002; IgA: 2g/l vs. 1.8g/l, p = 0.0010; IgM: 1.8g/l vs. 0.7g/l, p < 0.0001). Serum KFLC concentration did not correlate with clinical and paraclinical parameters of disease activity. Treatment with ocrelizumab reduces serum KFLC concentration in MS patients. However, serum KFLC concentration is not able to predict disease activity in these MS patients.

Neurovascular networks (NVNs) in Germany are supra-regional care structures for patients with neurovascular diseases. Each NVN consists of a tertiary care center serving as the coordinating center-in some cases, two or three coordinating centers-and at least three partner hospitals. Since 2018, 19 neurovascular networks (NVNs) have been audited and certified. NVNs play a crucial role in stroke care in Germany, as first described and quantified in 2020. The present article provides an update on interdisciplinary NVNs in Germany and outlines recent developments in neurovascular patient care. Audit reports from 19 NVNs, certified between 2021 and 2024, were analyzed, and compared to previously reported data from 2017 to 2019. Additionally, structural and quality-related parameters for coordinating centers and partner hospitals were compared. The number of NVNs increased from 15 to 19, with approximately 120,000 from an estimated 262,000 neurovascular patients in Germany now treated annually in certified NVN hospitals. In particular, annual thrombectomy rates at coordinating centers have increased over-proportionally (> 4400, as compared to previously < 2500), and surgical treatments for intracerebral hemorrhages have also increased. Process times-door-to-needle and door-to-groin times-remained stable or exhibited slight increases. Substantial variability was observed among NVN partner hospitals regarding procedural volumes. The treatment of patients with neurovascular diseases in Germany has expanded considerably within certified NVN hospitals in recent years. The NVNs ensure comprehensive, high-quality stroke care nationwide.

BackgroundIn Germany, multidisciplinary care for people with Parkinson's disease (PwP, PD) is mainly provided in the inpatient setting. Differences in user groups between established and effective interventions like PD Multimodal Complex Therapy (PD-MCT) and Geriatric Complex Therapy (GCT) have not been investigated.MethodsThis real-world bicenter prospective observational study involved PwP undergoing 14-day inpatient multidisciplinary therapies at two German university hospitals providing either PD-MCT or GCT. Demographic and clinical variables were recorded before and device-based gait variables before and after therapy. Non-parametric and parametric tests including ANCOVA with age as covariate were conducted to compare groups at baseline, and an exploratory binomial logistic regression (LR) to identify predictors of ‘therapy response’ concerning gait speed.ResultsBetween 09/2017 and 09/2022, 100 (41% female) and 102 (34.3% female) PwP received GCT or PD-MCT, with significant (p < 0.003) mean or median differences (GCT vs. PD-MCT) in age (74.7 vs. 65.6 years), disease duration (9.9 vs. 7.4 years), and HY stage (3 vs. 2.5). The GCT group showed significantly reduced lower extremity (SPPB), global cognitive (MoCA) and executive function (TMT), lower quality of life, and higher fear of falling (FES-I). There were significant (p < 0.004) between-group differences in gait parameters at both normal and fast pace, e.g., reduced gait speed and step length among GCT users. After age-adjustment, differences in gait speed, fast-pace step length, lower extremity and executive function, fear of falling and quality of life persisted. The exploratory LR model was statistically significant (p < 0.05, R2 = 0.312) and revealed lower fear of falling and gait speed as predictors of ‘therapy response’, independent of therapy type, age, sex, disease duration or stage.ConclusionGCT users show higher age and severity, particularly concerning mobility impairments independent of age. It is unclear if, on a national level, actual PD-MCT/GCT user groups align with intended target groups. Health insurance data analyses could help refine clinical recommendations and public health policies for more targeted multidisciplinary PD care.Trial registrationPark Move Study: DRKS, DRKS00020948. Registered 30 March 2020—retrospectively registered, https://drks.de/search/de/trial/DRKS00020948/detailsSupplementary InformationThe online version contains supplementary material available at 10.1186/s42466-025-00409-9.

IntroductionA decade ago, endovascular therapy (EVT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) has been established as standard of care. It is still a matter of debate whether EVT is better and safe for patients with more distal occlusions (DMVO). Three randomized controlled trials investigated the role of EVT on top of best medical treatment (BMT) for patients with DMVO.MethodsIn a narrative review we present the results of 3 randomized controlled trials (RCT), (DISTAL, ESCAPE MeVO, DISCOUNT) of EVT plus BMT versus BMT alone. In addition, we performed a study level meta-analysis with a random-effects model for three endpoints: independent outcome, symptomatic intracranial hemorrhage (sICH) and death.ResultsThere was neither a significant effect of EVT plus BMT versus BMT alone on functional outcome (RR 0.92, 95% CI 0.80–1.06, p = 0.272), nor did the odds of death differ (OR 1.23, 95% CI 0.76–1.99, p = 0.409). The odds for sICH were more than twice as high with EVT (OR 2.38, 95% CI 1.35–4.20, p = 0.003).ConclusionAt present EVT for medium and distal vessel occlusions in AIS patients is not a standard of care. With equipoise for EVT in DMVO now an unbiased and rapid randomization into new and differently designed RCT should be a top priority.

BackgroundAdmission glycemia has emerged as an important outcome predictor in the context of mechanical thrombectomy (MT) for large vessel occlusions (LVO) in ischemic stroke. However, a clinically relevant threshold of glucose levels to identify patients at risk for poor functional outcome has yet to be established.MethodsWe conducted a retrospective, monocentric, consecutive registry-based analysis of patients who underwent MT for anterior circulation LVO. Good outcome was defined as functional independence after 90 days (90d mRS < 3) or no deterioration from premorbid mRS. We performed a multiple logistic regression analysis to assess the association between admission glucose levels and functional outcome, including for well-established outcome predictors, i.e. age, NIHSS, Alberta Stroke Program Early CT Score (ASPECTS), time to reperfusion, unsuccessful recanalization, presence of bleeding, and diabetes. In addition, we conducted a receiver operating characteristic (ROC) analysis to determine the optimal admission glucose threshold that best discriminates patients at risk for poor outcome, maximizing sensitivity and specificity.ResultsWe analyzed 509 patients (mean age = 74.3 ± 12.6 years, median previous mRS = 1.5, 48% male). 194 patients (38.1%) had good outcome and 315 (61.9%) had poor outcome. According to the logistic regression admission glucose (p = 0.012, OR 1.009 95% CI [1.002 1.016]) contributed to predicting poor outcome, while known diabetes did not show a significant contribution. The ROC analysis revealed an admission glucose of 117 mg/dL (59.7% sensitivity; 58% specificity) to be the optimal cut-off value to discriminate patients at risk for poor outcome with an OR of 2.3.ConclusionAdmission hyperglycemia is an independent predictor of poor outcome after MT for LVO in the anterior circulation. We hypothesize, that optimal glucose values in patients undergoing MT will likely be in the low normoglycemic range. Prospective controlled studies with targeted glucose values will be needed for validation.