Intra-arterial thrombolytics after successful recanalization in endovascular thrombectomy for large-vessel occlusion acute ischemic stroke: A comprehensive meta-analysis of randomized controlled trials

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-01 DOI:10.1016/j.clineuro.2025.109139

Wei Jun Lee , Rafaela Correia Maciel , Henrique Alexsander Ferreira Neves , Rahim Abo Kaseem , Luana Miyahira Makita , Ong Zhi Inn , Tam QM Tran , Tan Ya Wen , Adam Dmytriw , Robert Regenhardt

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引用次数: 0

Abstract

Background

Intra-arterial thrombolytics (IAT) as adjunctive therapy for large vessel occlusion acute ischemic stroke (LVO-AIS) after successful endovascular thrombectomy (EVT) may improve outcomes. This meta-analysis evaluates the efficacy and safety of IAT in this context.

Methods

We identified randomized controlled trials (RCTs) comparing IAT versus placebo or no IAT in LVO-AIS patients with successful recanalization post-EVT, including published studies and recent conference data. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days. Secondary outcomes included other mRS 0–2 at 90 days, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Pooled risk ratios (RRs) with 95 % confidence intervals (CIs) were calculated using a random-effects model; heterogeneity was assessed using the I² statistic.

Results

Six RCTs comprising 1972 patients (990 IAT, 982 control) were included. IAT was associated with a higher likelihood of excellent outcome at 90 days (RR = 1.25; 95 % CI: 1.07–1.46; p = 0.01; I² = 16 %). There were no significant differences in functional independence (mRS 0–2) (RR = 1.06; 95 % CI: 0.97–1.17; p = 0.15), sICH (RR = 1.14; 95 % CI: 0.70–1.85; p = 0.52), or 90-day mortality (RR = 1.00; 95 % CI: 0.79–1.27; p = 0.99); heterogeneity was low across these outcomes (I² = 0 %).

Conclusion

Adjunct IAT after successful EVT significantly improves excellent functional outcomes at 90 days without increasing sICH or mortality. However, its effect on broader disability outcomes is uncertain. Further trials are needed to refine patient selection.

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大血管闭塞急性缺血性卒中血管内取栓成功再通后动脉内溶栓：一项随机对照试验的综合meta分析

背景：血管内溶栓（EVT）成功后，动脉溶栓（IAT）作为大血管闭塞急性缺血性卒中（LVO-AIS）的辅助治疗可能改善预后。本荟萃分析评估了IAT在这种情况下的有效性和安全性。方法：我们选取了随机对照试验（rct），比较IAT与安慰剂或不IAT在evt后成功再通的LVO-AIS患者中的疗效，包括已发表的研究和最近的会议数据。主要终点为90天的良好功能预后（改良Rankin量表[mRS] 0-1）。次要结局包括90天时其他mRS 0-2、症状性颅内出血（siich）和90天死亡率。采用随机效应模型计算95 %置信区间（ci）的合并风险比（rr）；采用I²统计量评估异质性。结果纳入6项随机对照试验，共纳入1972例患者（试验组990例，对照组982例）。IAT与90天获得良好结局的可能性较高相关（RR = 1.25; 95 % CI: 1.07-1.46; p = 0.01;I²= 16 %）。夫人在独立功能没有明显差异(0 - 2)(RR = 1.06; 95 %置信区间:0.97 - -1.17;p = 0.15),西奇(RR = 1.14; 95 %置信区间:0.70 - -1.85;p = 0.52),或90天的死亡率(RR = 1.00; 95 %置信区间:0.79 - -1.27;p = 0.99);这些结果的异质性较低（I²= 0 %）。结论EVT成功后的辅助IAT可显著改善90天的功能预后，且未增加sICH或死亡率。然而，它对更广泛的残疾结果的影响是不确定的。需要进一步的试验来完善患者选择。

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

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.