Wang Zekun, Ji Kangxiang, Fang Qi
Department of Neurology, The First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Gusu District, Suzhou, 215031, Jiangsu Province, China.
Department of Neurology, The Fourth Affiliated Hospital of Soochow University, No.9 Chongwen Road, Dushu Lake Science and Education Innovation Zone, Suzhou Industrial Park, Suzhou, 215125, Jiangsu Province, China.
J Neurol. 2025 Apr 17;272(5):345. doi: 10.1007/s00415-025-13092-2.
The benefits and risks of adjunctive intra-arterial thrombolysis (IAT) after successful endovascular thrombectomy (EVT) in acute ischemic stroke due to large vessel occlusion (AIS-LVO) remain uncertain. This study aimed to evaluate the efficacy and safety of IAT in this setting.
We systematically searched PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov from inception to February 2025, and reviewed abstracts from the 2025 International Stroke Conference, to identify randomized controlled trials (RCTs) comparing IAT versus placebo or best medical management in AIS-LVO patients who achieved successful reperfusion after EVT. Outcome measures included 90-day excellent (modified Rankin Scale [mRS] 0-1) and good (mRS 0-2) functional outcomes, 90-day reduced disability (≥ 1-point mRS improvement), symptomatic intracranial hemorrhage (sICH), any ICH, and 90-day mortality. A random-effects model was employed for the meta-analysis.
Seven RCTs with 2131 patients (1083 assigned to IAT, and 1048 to control) were included. Compared to controls, IAT was associated with significantly higher likelihood of 90-day excellent functional outcomes (risk ratio 1.23, 95% confidence interval [CI] 1.11-1.36; I = 0%) and reduced disability (common odds ratio 1.20, 95% CI 1.03-1.40; I = 0%), but not with 90-day good functional outcomes. Risks of any ICH, sICH, and mortality were similar between groups. Subgroup analyses suggested numerically higher odds of excellent functional outcomes among patients with anterior circulation LVO or those receiving IA alteplase/tenecteplase.
Adjunctive IAT following successful EVT in AIS-LVO patients led to improved 90-day excellent functional outcomes and reduced disability without increasing sICH or mortality risks.
对于因大血管闭塞（AIS-LVO）导致的急性缺血性卒中患者，在成功进行血管内血栓切除术（EVT）后，辅助性动脉内溶栓（IAT）的益处和风险仍不确定。本研究旨在评估在此情况下IAT的疗效和安全性。
我们系统检索了从创刊至2025年2月的PubMed、Embase、Web of Science、CENTRAL和ClinicalTrials.gov，并查阅了2025年国际卒中会议的摘要，以确定比较IAT与安慰剂或最佳药物治疗的随机对照试验（RCT），这些试验的研究对象为在EVT后实现再灌注的AIS-LVO患者。结局指标包括90天良好（改良Rankin量表[mRS] 0-1）和较好（mRS 0-2）功能结局、90天残疾程度降低（mRS改善≥1分）、症状性颅内出血（sICH）、任何颅内出血（ICH）以及90天死亡率。采用随机效应模型进行荟萃分析。
纳入了7项RCT，共2131例患者（1083例分配至IAT组，1048例分配至对照组）。与对照组相比，IAT与90天良好功能结局的可能性显著更高相关（风险比1.23，95%置信区间[CI] 1.11-1.36；I² = 0%），且残疾程度降低（共同优势比1.20，95% CI 1.03-1.40；I² = 0%），但与90天较好功能结局无关。两组间任何ICH、sICH和死亡率的风险相似。亚组分析表明，在前循环LVO患者或接受动脉内阿替普酶/替奈普酶治疗的患者中，良好功能结局的优势在数值上更高。
AIS-LVO患者在成功进行EVT后进行辅助性IAT可改善90天良好功能结局并降低残疾程度，且不增加sICH或死亡风险。
