Song Kangjia, Qi Shuang, Guo Zhenni, Shi Mingchao, Li Chao, Wang Zan, Wang Shouchun
Department of Neurology, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, 130021, Jilin, China.
J Neurol. 2025 Jul 31;272(8):548. doi: 10.1007/s00415-025-13289-5.
Mechanical thrombectomy (MT) is a primary treatment for acute ischemic stroke caused by large vessel occlusion. However, incomplete reperfusion is common and leads to poorer patient outcomes. Intra-arterial thrombolysis (IAT) is a potential rescue therapy, but its efficacy and safety remain controversial.
A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and Cochrane Library up to January 2025. The search included terms related to stroke, thrombectomy, thrombolysis, and intra-arterial. Studies comparing IAT as rescue therapy following MT with MT alone in patients with incomplete reperfusion were included. The primary outcome was functional independence (modified Rankin Scale [mRS] score of 0-2 at 90 days). Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model. This meta-analysis followed PRISMA guidelines and was registered with PROSPERO (CRD420251063825).
Seven studies, totaling 1893 patients (374 in MT + IAT; 1519 in MT alone) were included. Pooled analysis indicated that IAT as a rescue therapy was associated with significantly higher odds of functional dependence at 90 days (OR 1.40, 95% CI 1.06-1.83; p = 0.017) and lower 90-day mortality (OR 0.69, 95% CI 0.49-0.98; p = 0.036). There was no statistically significant increase in the risk of intracranial hemorrhage (OR 0.72, 95% CI 0.46-1.11; p = 0.132) or symptomatic intracranial hemorrhage (OR 1.10, 95% CI 0.59-2.03; p = 0.768) associated with IAT.
In patients with incomplete reperfusion after MT, IAT as rescue therapy improved functional outcomes and reduced mortality within 90 days, without increasing the risk of ICH or sICH.
机械取栓术（MT）是治疗大血管闭塞所致急性缺血性卒中的主要方法。然而，再灌注不完全很常见，会导致患者预后较差。动脉内溶栓（IAT）是一种潜在的补救治疗方法，但其疗效和安全性仍存在争议。
截至2025年1月，在PubMed、Scopus、Web of Science和Cochrane图书馆进行了全面的文献检索。检索词包括与卒中、取栓术、溶栓和动脉内相关的术语。纳入了比较在再灌注不完全的患者中，IAT作为MT后的补救治疗与单纯MT的研究。主要结局是功能独立性（90天时改良Rankin量表[mRS]评分为0 - 2分）。使用随机效应模型计算合并比值比（OR）和95%置信区间（CI）。本荟萃分析遵循PRISMA指南，并在PROSPERO（CRD420251063825）注册。
纳入了7项研究，共1893例患者（MT + IAT组374例；单纯MT组1519例）。汇总分析表明，IAT作为补救治疗与90天时功能依赖的显著更高几率相关（OR 1.40，95% CI 1.06 - 1.83；p = 0.017），且90天死亡率更低（OR 0.69，95% CI 0.49 - 0.98；p = 0.036）。与IAT相关的颅内出血风险（OR 0.72，95% CI 0.46 - 1.11；p = 0.132）或症状性颅内出血风险（OR 1.10，95% CI 0.59 - 2.03；p = 0.768）没有统计学显著增加。
在MT后再灌注不完全的患者中，IAT作为补救治疗可改善功能结局并降低90天内的死亡率，且不增加颅内出血（ICH）或症状性颅内出血（sICH）的风险。
