Episode 421: 428. Asthma and Stroke --- A breathless combination

Minocycline in Acute Ischemic Stroke (EMPHASIS trial)

A multicenter, double-blind RCT in China studied 1,724 patients with acute ischemic stroke treated within 72 hours of onset. Patients received either a 4.5-day course of oral minocycline or placebo. Minocycline works by inhibiting microglial activation, which contributes to post-stroke inflammation.

Primary outcome: 52.6% of minocycline patients vs. 47.4% of placebo patients achieved good functional recovery (mRS 0–1) at 90 days (p=0.0061).
Safety: No difference in adverse events.
Practice impact: Clinicians are cautiously optimistic; further positive trials could lead to selective use of minocycline in AIS patients.

2. Tenecteplase for Basilar Artery Stroke (TRACE-5 trial)

This phase 3 RCT in China tested IV tenecteplase given within 24 hours of ischemic basilar artery occlusion against standard medical care (both groups could undergo thrombectomy).

Results: At 90 days, 38% of tenecteplase patients vs. 29% of controls had no or minimal disability (mRS 0–1 or baseline).
Safety: Similar rates of intracranial hemorrhage (2–3%) and mortality (29–31%).
Practice impact: Promising expansion of the thrombolytic window for severe posterior strokes; more evidence needed before routine use outside research settings.

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