Adjunctive Thrombolytics After Successful Endovascular Reperfusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2025-08-13 DOI:10.1002/ana.70021

Mohamed F Doheim, Mahmoud H Mohammaden, Ammar Jumah, Qingwu Yang, Wenjie Zi, Yangmei Chen, Yamei Tang, Yajie Liu, Xiaochuan Huo, Liping Liu, Bernard Yan, Zhongrong Miao, Wei Hu, Chunrong Tao, Xinfeng Liu, Liqun Jiao, Xuesong Bai, Wenhuo Chen, Diogo C Haussen, Thanh Nguyen, Raul G Nogueira

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引用次数: 0

Abstract

Objective: The efficacy and safety of intra-arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in large vessel occlusion strokes (LVOS) remain uncertain, with recent randomized controlled trials (RCTs) yielding conflicting results. This meta-analysis aimed to assess the impact of IAT following successful EVT in patients with LVOS.

Methods: A comprehensive search was conducted across PubMed, ClinicalTrials.gov, the Cochrane Library databases, and the International Stroke Conference 2025 abstracts to identify RCTs evaluating IAT following successful EVT from January 2015 to February 2025. The primary outcome was the odds of achieving an excellent functional outcome (defined as a modified Rankin Scale [mRS] = 0-1 at 90 days). Secondary outcomes included 90-day functional independence (mRS = 0-2). Safety measures included symptomatic intracranial hemorrhage (sICH), and mortality at 90 days. The protocol was registered in PROSPERO (CRD420250651602).

Results: The primary pooled analysis of 6 RCTs (N = 1,974) showed that IAT significantly increased the likelihood of achieving excellent functional outcome at 90 days (mRS = 0-1: odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.21-1.80, p < 0.001), with a notable effect in anterior circulation (OR = 1.48, 95% CI = 1.18-1.87, p < 0.001) but not in posterior circulation LVOS (OR = 1.51, 95% CI = 0.83-2.74, p = 0.18). Among thrombolytic drugs, alteplase was most strongly associated with favorable outcomes (mRS = 0-1: OR = 1.94, 95% CI = 1.31-2.87, p < 0.001), followed by tenecteplase (OR = 1.43, 95% CI = 1.08-1.89, p = 0.01). No significant safety concerns were observed, as there was no increase in the odds of sICH (OR = 1.15, 95% CI = 0.75-1.75, p = 0.51) or 90-day mortality (OR = 1.00, 95% CI = 0.79-1.26, p = 0.99). Sensitivity analyses for all outcomes yielded consistent results.

Interpretation: IAT following successful EVT significantly enhances the likelihood of achieving an excellent functional outcome, particularly in anterior circulation strokes. Although the benefit in posterior circulation strokes remains uncertain, the lack of significant differences in sICH risk and mortality across thrombolytic drugs and stroke locations support the safety of IAT. ANN NEUROL 2025.

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血管内再灌注成功后的辅助性溶栓：随机对照试验的系统回顾和荟萃分析。

目的：动脉内溶栓（IAT）作为血管内取栓（EVT）辅助治疗大血管闭塞性卒中（LVOS）的有效性和安全性仍不确定，最近的随机对照试验（RCTs）得出了相互矛盾的结果。本荟萃分析旨在评估LVOS患者EVT成功后IAT的影响。方法：综合检索PubMed、ClinicalTrials.gov、Cochrane图书馆数据库和2025年国际卒中会议摘要，以确定2015年1月至2025年2月评估EVT成功后IAT的随机对照试验。主要终点是达到良好功能预后的几率（定义为90天时修改的Rankin量表[mRS] = 0-1）。次要结局包括90天功能独立（mRS = 0-2）。安全措施包括症状性颅内出血（siich）和90天死亡率。该协议在PROSPERO （CRD420250651602）中注册。结果：6项随机对照试验（N = 1974）的初步合并分析显示，IAT显著增加了在第90天获得良好功能结局的可能性（mRS = 0-1：优势比[OR] = 1.47, 95%可信区间[CI] = 1.21-1.80, p）。解释：EVT成功后的IAT显著提高了获得良好功能结局的可能性，尤其是在前循环卒中中。尽管后循环卒中的益处仍不确定，但溶栓药物和卒中部位在siich风险和死亡率方面缺乏显著差异，这支持了IAT的安全性。Ann neurol 2025。

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

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.