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Ragavendra Baliga: This Week’s 3 Major Trials to Reshape Adjunctive Reperfusion Strategies in Acute Ischemic Stroke
May 9, 2026, 14:38

Ragavendra Baliga: This Week’s 3 Major Trials to Reshape Adjunctive Reperfusion Strategies in Acute Ischemic Stroke

Ragavendra Baliga, Editor-In-Chief of the Textbook of Internal Medicine, Professor of Internal Medicine and Faculty Cardiologist at The Ohio State University Wexner Medical Center, shared on LinkedIn:

Three major stroke trials published in JAMA this week may reshape adjunctive reperfusion strategies in acute ischemic stroke.

  • TNK-PLUS: Tenecteplase before thrombectomy in late-window stroke showed no added functional benefit.
  • CHOICE-2: Intra-arterial alteplase after successful thrombectomy improved excellent neurological recovery, though mortality signals warrant caution.
  • INSTANT: Early tirofiban after inadequate tenecteplase response significantly improved 90-day outcomes in non-large vessel occlusion stroke.

Together, these studies highlight a growing shift from merely reopening arteries toward optimizing microvascular reperfusion and tissue recovery.”

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