Jiang Xin, Zhao Zixu, Zhang Ying, Luo Wei, Zheng Keyang, Zhang Minghui, Li Enze, Lang Hui, Wang Jian, Zhou Can, He Li
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, China.
Neurology. 2025 Aug 12;105(3):e213842. doi: 10.1212/WNL.0000000000213842. Epub 2025 Jun 27.
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.
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).
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.
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.
本系统评价和荟萃分析旨在评估大血管闭塞（LVO）所致急性缺血性卒中（AIS）患者血管内再通术后动脉内溶栓（IAT）的治疗效果。血管内再通是大血管闭塞（LVO）性卒中的标准治疗方法。尽管血栓切除术后成功实现了再灌注，但不到一半的患者在90天时恢复了功能独立，这突出了微循环受损在不良神经结局中的潜在作用。血管内再通术后动脉内溶栓（IAT）的疗效和安全性仍存在争议。本系统评价和荟萃分析旨在评估LVO所致AIS患者血管内再通术后IAT的治疗效果。
我们基于PubMed、Embase、CENTRAL和ClinicalTrials.gov进行了一项研究水平的系统评价和荟萃分析，时间范围从数据库建立至2025年2月8日。仅纳入报告了大血管闭塞性卒中血管内再通术后IAT疗效和安全性的随机对照试验（RCT）。使用偏倚风险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汇总数据进行分析。我们的主要结局是90天时改良Rankin量表（mRS）评分为0 - 1的患者比例。其他结局包括90天时mRS评分为0 - 2的患者比例、90天全因死亡率、48小时内症状性颅内出血和任何颅内出血。研究方案已在PROSPERO（CRD42025639519）上注册。
共有6项RCT，1985例初始入组患者纳入分析。IAT组90天时mRS评分为0 - 1的比例更高（风险比[RR] 1.25，95%可信区间[CI] 1.11 - 1.41）。两组间90天时mRS评分为0 - 2的比例无显著差异（RR 1.04，95% CI 0.96 - 1.13）。关于安全性结局，IAT组和对照组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。
在LVO所致AIS患者中，血管内再通术后IAT可增加功能结局的额外益处，且不增加死亡或颅内出血风险。
