Efficacy and safety of adjunctive intra-arterial thrombolysis after successful recanalization in patients with large vessel occlusion acute ischemic stroke: A systematic review and meta-analysis
European Journal of Pharmacology, cilt.1004, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 1004
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.ejphar.2025.178000
- Dergi Adı: European Journal of Pharmacology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Aquatic Science & Fisheries Abstracts (ASFA), BIOSIS, Biotechnology Research Abstracts, CAB Abstracts, Chemical Abstracts Core, Chimica, EMBASE, Food Science & Technology Abstracts, Veterinary Science Database
- Anahtar Kelimeler: Acute ischemic stroke, Endovascular thrombectomy, Intra-arterial thrombolysis, Large vessel occlusion, Recanalization
- Ankara Yıldırım Beyazıt Üniversitesi Adresli: Evet
Özet
Background: While endovascular thrombectomy (EVT) achieves recanalization in acute large vessel occlusion (LVO) stroke, residual or recurrent distal emboli can undermine clinical outcomes. This meta-analysis examines whether adjunctive intra-arterial thrombolysis (IAT) administered post-EVT improves therapeutic efficacy without compromising safety. Methods: A systematic search of PubMed, Scopus, Cochrane Library, and Web of Science (up to May 25, 2025) was conducted to identify randomized controlled trials (RCTs), comparing adjuvant intra-arterial thrombolysis to EVT alone in patients with large vessel occlusion undergoing successful EVT. Statistical analysis was performed using RStudio (v4.4.2) with a random-effects model. Results: Our meta-analysis of four RCTs (1375 patients) demonstrated that adjunctive IAT significantly increased the probability of excellent functional outcome (modified Rankin Scale 0–1) at 90 days (RR 1.16; 95 % CI 1.03–1.31; P = 0.01) and reduced neurological deficit NIHSS scores (MD, −0.75; 95 % CI, −1.4 to −0.10; P = 0.02) compared to EVT alone. No significant differences were observed for 90-day mortality (RR: 0.94, 95 % CI: 0.76–1.17; P = 0.57). Furthermore, the analysis showed a statistically significant, albeit marginal, increase in radiological intracranial hemorrhage (RR: 1.26, 95 % CI: 1.00–1.58; P = 0.045), without a corresponding increase in symptomatic intracranial hemorrhage or systemic bleeding. Conclusion: Adjuvant IAT after successful recanalization may improve functional outcomes in acute ischemic stroke patients without increasing risks. Future studies should focus on identifying ideal candidates and investigating adjunctive approaches to improve microvascular reperfusion. Systematic review protocol: CRD420251001384 (PROSPERO)