Braydon Dymm, MD

The main event concluded with Tirofiban for Branch Atheromatous Disease-Related Stroke (aka STRATEGY):

This trial was unable to show a significant effect.

Compare to last year’s trial with argatroban (PubMed: 40242875).

Following up on the MMA embolization trials that dominated ISC in 2024, EMBOLISE found a 2-fold reduction in the composite primary outcome.

TNK-PLUS examined TNK for late-presenting ischemic stroke patients, but unlike OPTION, they included thrombectomy patients. This design mirrors TIMELESS.

And just like TIMELESS, they did not see functional improvement when TNK was combined with thrombectomy.

This was immediately followed by similar study focusing on late-presenting posterior circulation strokes who get thrombectomy: ATTENTION LATE

In contrast, there was no significant difference in outcomes.

Next up: “Tenecteplase for acute non-large vessel occlusion at 4.5-24 hours” aka OPTION

Results support treatment for a higher likelihood of an excellent functional outcome than standard medical care, although an increased risk of symptomatic intracranial hemorrhage.

This positive effect for asundexian was consistent across many subgroups.

Starting with a bang, OCEANIC-STROKE found that asundexian, a factor XIa inhibitor, had an ischemic stroke risk reduction without an increase in hemorrhage.

On Day 2 of #ISC26, there are practice-changing trials being announced.

Find out these results below 👇

Dr. Nishita Singh disagrees!

Close Neuro-monitoring is essential to act on complications as soon as possible.

The OPTIMISTmain (Optimal Post Tpa-Iv Monitoring in Ischemic Stroke) trial was not convincing to allow a more relaxed approach.

Dr. Anderson says that low-intensity monitoring is safe for clinically stable stroke patients with NIHSS <10, with no meaningful outcome differences.

Hospitals should consider adopting based on local resources and stakeholder input.

Where should post-treatment stoke patients go?

Majority voted —> straight to the ICU with you!

Well, Dr. Craig Anderson doesn’t agree…

Starting Day 2 of #ISC26 with Stroke in 2026: Navigating Controversies in Ischemic Stroke Treatment (Debate)

Open this thread for the hot takes 👇

CREST-2: The study concluded that for patients with asymptomatic carotid artery stenosis, adding surgical interventions like stenting or endarterectomy to intensive medical management provided no cognitive benefit over medical management alone.

FASTEST: This trial found that while recombinant factor VIIa slowed hematoma growth in acute intracerebral hemorrhage patients when administered early, it did not improve overall functional outcomes and was associated with a slightly increased risk of thromboembolic complications.

Are you here?

CHOICE-2: This Phase III trial demonstrated that administering intra-arterial alteplase after a successful thrombectomy improved functional outcomes in patients with large-vessel occlusion acute ischemic stroke compared to thrombectomy alone.

For those who couldn’t make it for #ISC26 Day 1’s Main Event…

See thread for the results from these high impact clinical trials 🧵

I’ve joined @americanheart.bsky.social’s Heart Powered to advocate for quality stroke care and healthy communities. #ISC26

If you want to join too, text STROKE to 46839

Starting #ISC26 by asking (and answering!) the tough questions: “Grey Areas: Decision Making in Difficult Cases”

Excellent attendance for Day 1, 7:30am

New Orleans here we come! ✈️ #ISC26

I did some more digging and discovered it’s a vintage pun from the 80s

I can’t believe no one has noticed this pun yet

Got the final concept for my custom backer reward weapon in Beaten Path!

Synapse Breaker: an epic axe inspired by neuroscience and the brain. Can't wait to see it in-game.

Springer Nature Link Journal of Clinical Sleep Medicine The effect of standard time to daylight-saving clock transition on sleep and migraine headaches Original Article Published: 20 January 2026 Volume 22, article number 18, (2026) Journal of Clinical Sleep Medicine Sasikanth Gorantla, Abhilash Velaga, Ashwath Ravisankar, Hrachya Nersesyan, Krishna M. Sundar & Karin G. Johnson

📒 NEW STUDY “supports abolition of Daylight Saving Time and adoption of permanent Standard Time to minimize negative consequences including migraines.”

Column | I let ChatGPT analyze a decade of my Apple Watch data. Then I called my doctor. I gave the new ChatGPT Health access to 29 million steps and 6 million heartbeat measurements. It drew questionable conclusions that changed each time I asked.

The performance of the newly released ChatGPT Health, via a thorough assessment by @geoffreyfowler.bsky.social
with his health data, is very disappointing
gift link wapo.st/49GEASP

TNK for Acute Stroke - Is "4.5 hours from LKN" dead?

Find the link here: live.avomd.io/algo/01542d1...

Btw, if @ahascience.bsky.social is interested in sponsoring (rubber stamping this), please reach out!

Today, new Stroke Guidelines were published. They include an update to the classic CHANCE/POINT protocol, but the flowchart may be confusing at first glance.

I built an interactive version to simplify!

Today, we are also dropping Neuroglyphs: Secrets of Medullary Pyramid! www.neurdgames.com/neuroglyphs

This is a 2-player game about the anatomy of the brainstem, set in Egypt in the 1920s.

Made with @MikaelaStiver (who also did a lot of the art) and Jeremy Grachan.