Adjunctive Intra-Arterial Thrombolysis Following Endovascular Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging Pub Date : 2025-05-25 DOI:10.1111/jon.70054

Mohammed M. Al-Salihi, Maryam S. Al-Jebur, Ram Saha, Ahmed Abd Elazim, Farhan Siddiq, Adnan I. Qureshi

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引用次数: 0

Abstract

Background and purpose

Despite significant advances in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), approximately 30%–40% of patients experience futile recanalization. This meta-analysis aimed to assess the effectiveness and safety of adjunctive intra-arterial thrombolysis (IAT) following EVT in individuals with AIS.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared IAT after EVT with standard care. A literature search was conducted across multiple databases up to March 2025. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days, functional independence (mRS 0–2), and mortality rate. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals.

Results

Six RCTs comprising 1971 patients were included. Adjunctive IAT significantly increased excellent functional outcomes at 90 days (RR = 1.24 [1.12–1.39], p < 0.0001), without significant improvement in functional independence (RR = 1.04 [0.96–1.13], p = 0.34). The IAT group exhibited significantly higher EuroQol 5 dimensions scores (MD = 0.08 [0.03–0.13], p = 0.001). Mortality rates were comparable (RR = 1.01 [0.84–1.23], p = 0.89). No significant differences were observed in any intracerebral hemorrhage (RR = 1.15 [1.00–1.33], p = 0.08), symptomatic intracerebral hemorrhage (RR = 1.13 [0.76–1.68], p = 0.53), or systemic bleeding complications.

Conclusions

Adjunctive IAT following EVT significantly enhances excellent functional recovery and health-related quality of life after AIS, without significantly increasing hemorrhagic complications. These findings support the consideration of IAT as a complementary strategy following mechanical thrombectomy in AIS patients who present within 24 h of symptom onset.

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急性缺血性卒中血管内取栓后辅助动脉内溶栓：一项荟萃分析

背景和目的尽管血管内血栓切除术（EVT）治疗急性缺血性卒中（AIS）取得了重大进展，但约30%-40%的患者经历了无效的再通。本荟萃分析旨在评估AIS患者EVT后辅助动脉内溶栓（IAT）的有效性和安全性。方法：我们对比较EVT后IAT与标准治疗的随机对照试验（rct）进行了系统回顾和荟萃分析。截至2025年3月，对多个数据库进行了文献检索。主要转归为90天的良好功能转归（改良Rankin量表[mRS] 0-1）、功能独立性（mRS 0-2）和死亡率。以95%置信区间计算二分类结果的风险比（rr）和连续变量的平均差异（MDs）。结果纳入6项随机对照试验，共纳入1971例患者。辅助IAT显著增加了90天的良好功能预后(RR = 1.24 [1.12-1.39], p <；0.0001)，功能独立性无显著改善（RR = 1.04 [0.96-1.13], p = 0.34）。IAT组EuroQol 5维度得分显著高于对照组（MD = 0.08 [0.03-0.13], p = 0.001）。死亡率具有可比性（RR = 1.01 [0.84-1.23], p = 0.89）。两组脑出血发生率（RR = 1.15 [1.00-1.33], p = 0.08）、症状性脑出血发生率（RR = 1.13 [0.76-1.68], p = 0.53）、全身性出血并发症发生率无统计学差异。结论EVT后辅助IAT可显著提高AIS患者良好的功能恢复和健康相关生活质量，且未显著增加出血性并发症。这些发现支持将IAT作为机械取栓后24小时内出现症状的AIS患者的补充策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!