Intra-Arterial Thrombolysis Following Endovascular Recanalization for Large Vessel Occlusion Stroke: A Systematic Review and Meta-Analysis.

IF 8.5 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-08-12 Epub Date: 2025-06-27 DOI:10.1212/WNL.0000000000213842

Xin Jiang, Zixu Zhao, Ying Zhang, Wei Luo, Keyang Zheng, Minghui Zhang, Enze Li, Hui Lang, Jian Wang, Can Zhou, Li He

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引用次数: 0

Abstract

Background and objectives: This systematic review and meta-analysis aims to evaluate the treatment effects of intra-arterial thrombolysis (IAT) after endovascular recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Endovascular recanalization is the standard treatment for large vessel occlusion (LVO) stroke. Despite successful reperfusion after thrombectomy, fewer than half of the patients regain functional independence at 90 days, highlighting the potential role of impaired microcirculation in poor neurologic outcomes. The efficacy and safety of intra-arterial thrombolysis (IAT) after endovascular recanalization remains controversial. This systematic review and meta-analysis aims to evaluate the treatment effects of IAT after endovascular recanalization in patients with acute ischemic stroke (AIS) due to LVO.

Methods: We conducted a study-level systematic review and meta-analysis based on PubMed, Embase, CENTRAL, and ClinicalTrials.gov from database inception to February 8, 2025. Only randomized controlled trials (RCTs) reporting the efficacy and safety of IAT after endovascular recanalization in large vessel occlusion stroke were included. The risk of bias of the included studies was assessed using the Risk of Bias 2 tool. The pooled data were analyzed using a random-effects meta-analysis. Our primary outcome was the proportion of patients with modified Rankin Scale (mRS) scores 0-1 at 90 days. Other outcomes included the proportion of patients with mRS scores 0-2 at 90 days, all-cause mortality at 90 days, and symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. The study protocol was registered on PROSPERO (CRD42025639519).

Results: A total of 6 RCTs with 1,985 initially enrolled patients were included in the analysis. A higher proportion of mRS scores 0-1 at 90 days was observed in the IAT group (risk ratio [RR] 1.25, 95% CI 1.11-1.41). No significant differences were found in the proportion of mRS scores 0-2 at 90 days (RR 1.04, 95% CI 0.96-1.13) between the groups. Regarding safety outcomes, 90-day all-cause mortality (RR 1.00, 95% CI 0.83-1.21), symptomatic intracranial hemorrhage (RR 1.14, 95% CI 0.76-1.70), and any intracranial hemorrhage (RR 1.16, 95% CI 0.98-1.37) were similar in the IAT group and control group.

Discussion: Among patients with AIS due to LVO, IAT after endovascular recanalization adds additional benefits to functional outcomes, with no increased risk of death or intracranial hemorrhage.

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血管内再通后动脉内溶栓治疗大血管闭塞卒中：系统回顾和荟萃分析。

背景与目的：本系统综述和荟萃分析旨在评价大血管闭塞（LVO）急性缺血性卒中（AIS）患者血管内再通术后动脉内溶栓（IAT）的治疗效果。血管内再通术是大血管闭塞（LVO）卒中的标准治疗方法。尽管取血栓后再灌注成功，但不到一半的患者在90天内恢复功能独立，这突出了微循环受损在不良神经系统预后中的潜在作用。血管内再通后动脉内溶栓（IAT）的有效性和安全性仍然存在争议。本系统综述和荟萃分析旨在评价LVO所致急性缺血性卒中患者血管内再通术后IAT的治疗效果。方法：从数据库建立到2025年2月8日，我们基于PubMed、Embase、CENTRAL和ClinicalTrials.gov进行了一项研究级的系统评价和荟萃分析。仅纳入随机对照试验（rct），报告大血管闭塞卒中患者血管内再通后IAT的有效性和安全性。使用risk of bias 2工具评估纳入研究的偏倚风险。采用随机效应荟萃分析对合并数据进行分析。我们的主要终点是90天时改良兰金量表（mRS）评分为0-1分的患者比例。其他结果包括90天mRS评分为0-2的患者比例、90天全因死亡率、症状性颅内出血和48小时内任何颅内出血。研究方案已在PROSPERO上注册（CRD42025639519）。结果：共有6项随机对照试验纳入了1985例初始入组患者。IAT组90天mRS评分0-1的比例较高（风险比[RR] 1.25, 95% CI 1.11-1.41）。90天mRS评分0-2的比例在两组间无显著差异（RR 1.04, 95% CI 0.96-1.13）。关于安全性结果，IAT组和对照组的90天全因死亡率（RR 1.00, 95% CI 0.83-1.21）、症状性颅内出血（RR 1.14, 95% CI 0.76-1.70）和任何颅内出血（RR 1.16, 95% CI 0.98-1.37）相似。讨论：在LVO引起的AIS患者中，血管内再通术后的IAT增加了功能预后的额外益处，没有增加死亡或颅内出血的风险。

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

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.