Program

Executive Summary：
Hong-lie Jhou, MD, is an attending physician and interventional neurologist at Changhua Christian Hospital's Neurological Institute. He earned his medical degree from Kaohsiung Medical University and completed neurology residency, vascular neurology fellowship, and interventional neuroradiology fellowship at Changhua Christian Hospital. Dr. Jhou's clinical practice focuses on acute intra-arterial therapies for stroke and neurocritical care. He treats patients with cerebrovascular emergencies using interventional techniques and manages critically ill neurological patients. Dr. Jhou has authored over 15 peer-reviewed publications in stroke intervention and neurocritical care. His work encompasses both clinical practice and research in interventional neurology.

Lecture Abstract：
Recent Advances in Stroke Therapy (I): Acute Ischemic Stroke Management

Acute ischemic stroke management centers on two reperfusion strategies: thrombolysis and mechanical thrombectomy. Tenecteplase (TNK) is increasingly replacing Alteplase for intravenous thrombolysis, offering single-bolus dosing and comparable or superior recanalization in large-vessel occlusion (LVO), as shown in recent trials and meta-analyses. In bridging therapy, IV thrombolysis before thrombectomy remains standard for eligible LVO patients, though debate persists over its added benefit versus direct thrombectomy, especially in transferred patients where delays may blunt efficacy. Notably, the TenCRAOS trial found that TNK did not improve vision recovery in central retinal artery occlusion ("eye stroke") compared to aspirin, and was associated with more adverse events; thrombolysis is therefore not currently recommended for CRAO. Intra-arterial thrombolysis instead serves as an adjunctive therapy after mechanical recanalization, targeting the no-reflow phenomenon, in which microvascular or distal perfusion failure persists despite successful opening of the main vessel.

On the endovascular front, thrombectomy for medium and distal vessel occlusions (M2/M3, ACA, PCA) remains unclear. Of five randomized trials to date, three showed neutral results, while two more recent trials demonstrated benefit, particularly in patients with more severe baseline deficits, suggesting that patient selection may be key to identifying who benefits from extending thrombectomy beyond classic LVO. Most notably, the role of thrombectomy in minor stroke with LVO, historically managed medically, is now being actively investigated, as ongoing trials explore whether early intervention in patients with mild presenting deficits may reduce disability. Definitive results are still pending, but this evolving evidence may eventually challenge traditional practice and carries important implications for case management and patient selection.