Evidence map›Paper›PMID 40622116›Full record

SynthesisEuropean journal of neurology2025

The Added Benefit of Intra-Arterial Thrombolysis After Successful Recanalization by Endovascular Treatment: A Systematic Review and Meta-Analysis of Randomized-Controlled Clinical Trials.

Lina Palaiodimou, Nikolaos M Papageorgiou, Guillaume Turc, Benjamin Gory, Aikaterini Theodorou, Eleni Bakola, George Magoufis, Stavros Spiliopoulos, Michail Mantatzis, Nitin Goyal and 6 more

Abstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in European journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 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

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. 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
  3. Article
  4. Review
  5. Article
  6. Article
  7. ESO annual stroke evidence update 2025.European stroke journal · 2026
    Review
  8. Article
  9. Article
  10. Article
  11. 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

16 authors.

Lina PalaiodimouSecond Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
Nikolaos M PapageorgiouSecond Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
Guillaume TurcInstitute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France.
Benjamin GoryCHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, Nancy, France.ORCID 0000-0001-8424-4464
Aikaterini TheodorouSecond Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.ORCID 0000-0001-7229-2610
Eleni BakolaSecond Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
George MagoufisInterventional Neuroradiology Unit, Metropolitan Hospital, Piraeus, Greece.
Stavros SpiliopoulosInterventional Radiology Unit, Second Department of Radiology, 'Attikon' University General Hospital, National & Kapodistrian University of Athens, Athens, Greece.ORCID 0000-0003-1860-0568
Michail MantatzisRadiology Department of University Hospital of Thessaloniki, AHEPA, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece.ORCID 0000-0001-6197-3592
Nitin GoyalDepartment of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.ORCID 0000-0002-4699-0922
Marios ThemistocleousNeurosurgical Department, Pediatric Hospital of Athens, 'Agia Sophia', Athens, Greece.
Amrou SarrajDepartment of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Aristeidis H KatsanosDivision of Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada.ORCID 0000-0002-6359-0023
Urs FischerDepartment of Neurology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
Andrei V AlexandrovDepartment of Neurology, Banner University Hospital, University of Arizona College of Medicine, Phoenix, USA.
Georgios TsivgoulisSecond Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.ORCID 0000-0002-0640-3797

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) with large-vessel occlusion (LVO), many patients fail to achieve excellent functional outcomes. Post-EVT intra-arterial thrombolysis (IAT) has emerged as a potential adjunctive strategy to improve microvascular reperfusion and clinical recovery.

methodsWe conducted a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) comparing IAT plus best medical therapy (BMT) versus BMT alone in LVO-AIS patients with successful recanalization post-EVT. The primary efficacy outcome was 3-month excellent functional outcome [modified Rankin Scale (mRS)-score: 0-1]. Secondary efficacy outcomes included good functional outcome (mRS-score: 0-2) and reduced disability (mRS-score shift analysis) at 3 months. The primary safety outcome was symptomatic intracranial hemorrhage (sICH); secondary safety outcomes included any-ICH and 3-month all-cause mortality. Subgroup and network meta-analyses were performed evaluating the effects of different thrombolytic agents.

resultsSeven RCTs were included, comprising 1083 patients treated with IAT and 1048 patients treated with BMT alone. IAT was associated with higher likelihood of excellent functional outcome (RR: 1.23; 95% CI: 1.11-1.36; I

conclusionsIAT improves excellent functional outcomes without compromising safety in LVO-AIS patients with successful recanalization after EVT.

trial registrationThe prespecified protocol of the present systematic review and meta-analysis has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (registration ID: CRD420251035903).

Indexed as

Endovascular ProceduresFibrinolytic AgentsIschemic StrokeThrombectomyThrombolytic TherapyCombined Modality TherapyHumansRandomized Controlled Trials as TopicTreatment OutcomeFibrinolytic Agentsacute ischemic strokeendovascular treatmentintra‐arterial thrombolysismeta‐analysisrandomized‐controlled clinical trialsuccessful recanalizationsystematic review

Identifiers

PMID40622116
PMCPMC12231048

What Socratic holds

Textmetadata
LicenceCC BY
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.