Evidence map›Paper›PMID 40277355›Full record

SynthesisInternational journal of surgery (London, England)2025

Efficacy and safety of intra-arterial thrombolysis after endovascular reperfusion for acute ischemic stroke: a systematic review and meta-analysis of randomized trials.

Yu Guo, Guang Yang, Yuwei Ding, Chao Liu, Zhiyuan Shen, Hengzhu Zhang, Qiangji Bao, Wenmiao Luo

Abstract readNetwork Meta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of surgery (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Intra-arterial tenecteplase in acute ischemic stroke after successful endovascular thrombectomy: a meta-analysis of randomized controlled trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Pooled it
  4. Neurointerventional Advances in 2025.Stroke (Hoboken, N.J.) · 2026
    Article
  5. Observational
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Yu GuoDepartment of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
Guang YangDepartment of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu, China.
Yuwei DingDepartment of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
Chao LiuDepartment of Neurosurgery, Xiamen Susong Hospital, Xiamen, China.
Zhiyuan ShenDepartment of Neurosurgery, Xiamen Susong Hospital, Xiamen, China.
Hengzhu ZhangDepartment of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
Qiangji BaoDepartment of Neurosurgery, Guang'an People's Hospital, Guang'an, China.
Wenmiao LuoDepartment of Neurosurgery, Xiamen Susong Hospital, Xiamen, China.ORCID 0000-0003-0340-9867

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis pooled analysis aims to evaluate the efficacy and safety of intra-arterial thrombolysis (IAT) following near-complete to complete reperfusion by endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).

methodsWe conducted a search of PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) investigating the adjunct benefit of IAT in patients with AIS-LVO who had achieved a score on the Thrombolysis In Cerebral Infarction (TICI) scale of 2b-3 after EVT. Efficacy outcomes encompassed excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days, and functional independence (mRS 0-2). Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. A network meta-analysis (NMA) was performed to evaluate the effects of different types of intra-arterial thrombolytic agents on mRS 0-1.

resultsA total of 7 RCTs were included in the analysis, involving 2128 patients. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects model. The pooled results indicated that adjunctive IAT did not significantly improve the rate of functional independence (RR 1.04, 95% CI 0.96-1.13, P = 0.29). However, there was a significant increase in excellent functional outcome with adjunctive IAT (RR 1.23, 95% CI 1.11-1.36, P < 0.001). The pooled analysis did not demonstrate any differences between EVT + IAT and EVT only in rates of sICH (RR 1.23, 95% CI 0.81-1.85, P = 0.33) or 90-day mortality (RR: 0.98, 95% CI: 0.82-1.18; P = 0.86). The NMA found no significant difference in achieving mRS 0-1 among arterial adjunctive alteplase, tenecteplase, and urokinase following successful reperfusion.

conclusionsIAT as an adjunct to successful EVT appears to enhance excellent functional outcome in patients with AIS-LVO without a significant increase in sICH and mortality.

Indexed as

Endovascular ProceduresFibrinolytic AgentsIschemic StrokeReperfusionThrombectomyThrombolytic TherapyHumansRandomized Controlled Trials as TopicTreatment OutcomeFibrinolytic Agentsendovascular thrombectomyfunctional outcomeintra-arterial thrombolysisischemic stroke

Identifiers

PMID40277355
PMCPMC12165491

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.