SynthesisAnnals of neurology2025
Adjunctive Thrombolytics After Successful Endovascular Reperfusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Synthesis in Annals of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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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.
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.
Who cites it
6 citing papers in PubMed.
- Advances in Reperfusion Therapy and Cytoprotection for Acute Ischemic Stroke.Journal of cardiovascular development and disease · 2026Review
- Editorial: DISTALS and the future of distal medium vessel thrombectomy: proof of concept and persistent questions.Neuroradiology · 2026Article
- Individualized Treatment in Distal and Medium Vessel Occlusion Stroke Using a Validated Explainable Counterfactual Treatment Estimation Model.Annals of neurology · 2026Article
- Dose-Specific Intra-Arterial Thrombolysis After Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: A Network Meta-Analysis of Randomized Trials.Stroke (Hoboken, N.J.) · 2026Article
- MicroRNA-383-5p regulation of NADPH oxidase 4 alleviates hemorrhagic transformation and improves acute outcomes after endovascular recanalization in acute ischemic stroke.Frontiers in immunology · 2026Article
- No impact of intravenous thrombolysis on post thrombectomy transcranial Doppler pulsatility index.Frontiers in neurology · 2025Article
Corrections and comments
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Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe efficacy and safety of intra-arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in large vessel occlusion strokes (LVOS) remain uncertain, with recent randomized controlled trials (RCTs) yielding conflicting results. This meta-analysis aimed to assess the impact of IAT following successful EVT in patients with LVOS.
methodsA comprehensive search was conducted across PubMed, ClinicalTrials.gov, the Cochrane Library databases, and the International Stroke Conference 2025 abstracts to identify RCTs evaluating IAT following successful EVT from January 2015 to February 2025. The primary outcome was the odds of achieving an excellent functional outcome (defined as a modified Rankin Scale [mRS] = 0-1 at 90 days). Secondary outcomes included 90-day functional independence (mRS = 0-2). Safety measures included symptomatic intracranial hemorrhage (sICH), and mortality at 90 days. The protocol was registered in PROSPERO (CRD420250651602).
resultsThe primary pooled analysis of 6 RCTs (N = 1,974) showed that IAT significantly increased the likelihood of achieving excellent functional outcome at 90 days (mRS = 0-1: odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.21-1.80, p < 0.001), with a notable effect in anterior circulation (OR = 1.48, 95% CI = 1.18-1.87, p < 0.001) but not in posterior circulation LVOS (OR = 1.51, 95% CI = 0.83-2.74, p = 0.18). Among thrombolytic drugs, alteplase was most strongly associated with favorable outcomes (mRS = 0-1: OR = 1.94, 95% CI = 1.31-2.87, p < 0.001), followed by tenecteplase (OR = 1.43, 95% CI = 1.08-1.89, p = 0.01). No significant safety concerns were observed, as there was no increase in the odds of sICH (OR = 1.15, 95% CI = 0.75-1.75, p = 0.51) or 90-day mortality (OR = 1.00, 95% CI = 0.79-1.26, p = 0.99). Sensitivity analyses for all outcomes yielded consistent results.
interpretationIAT following successful EVT significantly enhances the likelihood of achieving an excellent functional outcome, particularly in anterior circulation strokes. Although the benefit in posterior circulation strokes remains uncertain, the lack of significant differences in sICH risk and mortality across thrombolytic drugs and stroke locations support the safety of IAT. ANN NEUROL 2025;98:1299-1314.
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Registered trials
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.