Intra-arterial thrombolysis after successful endovascular reperfusion for large vessel occlusion stroke: A meta-analysis of randomized seven controlled trials.

In 30 seconds

This systematic review and meta-analysis compared intra-arterial thrombolysis (IAT) with placebo after successful endovascular recanalization for acute ischemic stroke due to large-vessel occlusion. The primary analysis pooled three randomized controlled trials involving 1187 patients; four additional trials were used only in sensitivity analyses. IAT was associated with a higher rate of 90-day functional excellence than control (RR = 1.15, 95%CI = 1.01-1.3, P = .032). There were no significant between-group differences in functional independence, mortality, intracranial hemorrhage, or total adverse events.

Key findings

• IAT was associated with higher 90-day functional excellence than control (RR = 1.15, 95%CI = 1.01-1.3, P = .032).
• No significant differences were found in functional independence, mortality, symptomatic or any intracranial hemorrhage, or total adverse events.
• Subgroup analyses reported higher functional excellence with IAT among studies including eTICI 2b-3 patients (RR = 1.5, 95%CI = 1.23-1.82, P = .016) and among female patients (RR = 1.42, 95%CI = 1.15-1.75, P = .001).

Why it matters

Functional recovery remains incomplete for many patients after thrombectomy. These pooled randomized-trial findings suggest that adjunctive IAT may improve the chance of excellent function at three months without a detected increase in hemorrhagic events. The absence of improvement in functional independence and other outcomes, alongside the need for further validation, means the result should be interpreted as promising rather than definitive.

What to keep in mind

The primary analysis included only three published trials; four additional trials were restricted to sensitivity analyses. The review was not registered in PROSPERO, and the authors state that further research is needed.