The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Lue Chen; Qiqi Huo; Qi Wei; Thanh N. Nguyen; Mohamad K. Abdalkader; Shunfu Jiang; Min Luo; Yu Jing; Lanlan Yang; Shuang Wang; Huiping Jiang; Shiyu Wen; Minyue Sun; Wei Huang; Shaotong Chen; Jian Yi; Guangxiong Yuan; Hongfei Sang; Qing Wu Yang; Nongyan Wang; Zhongming Qiu; Duolao Wang; Bruce C.V. Campbell; Yufeng Tang

doi:10.1159/000547442

The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Lue Chen
, Qiqi Huo
, Qi Wei
, Thanh N. Nguyen
, Mohamad K. Abdalkader
, Shunfu Jiang
, Min Luo
, Yu Jing
, Lanlan Yang
, Shuang Wang
, Huiping Jiang
, Shiyu Wen
, Minyue Sun
, Wei Huang
, Shaotong Chen
, Jian Yi
, Guangxiong Yuan
, Hongfei Sang
, Qing Wu Yang
, Nongyan Wang

Zhongming Qiu, Duolao Wang, Bruce C.V. Campbell, Yufeng Tang

Clinical Sciences

Research output: Contribution to journal › Comment/debate

2 Citations (Scopus)

Abstract

Abstract – Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms “stroke”, “thrombectomy”, “intra-arterial thrombolysis”. The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0–1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models.

Results: Seven RCTs and 9 cohort studies with a total of 6, 258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0–1, RR: 1.24, 95% CI: 1.12–1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04–1.32).

Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0–1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.

Original language	English
Pages (from-to)	1-13
Number of pages	13
Journal	Cerebrovascular Diseases
Early online date	29 Jul 2025
DOIs	https://doi.org/10.1159/000547442
Publication status	E-pub ahead of print - 29 Jul 2025

Keywords

Acute ischemic stroke
Intra-arterial thrombolysis
Large vessel occlusion
Meta-analysis
Thrombectomy

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10.1159/000547442

Cite this

Chen, L., Huo, Q., Wei, Q., Nguyen, T. N., Abdalkader, M. K., Jiang, S., Luo, M., Jing, Y., Yang, L., Wang, S., Jiang, H., Wen, S., Sun, M., Huang, W., Chen, S., Yi, J., Yuan, G., Sang, H., Yang, Q. W., ... Tang, Y. (2025). The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis. Cerebrovascular Diseases, 1-13. Advance online publication. https://doi.org/10.1159/000547442

@article{8e16fd95542f46c2a663f43678b0ee97,

title = "The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis",

abstract = "Abstract – Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms “stroke”, “thrombectomy”, “intra-arterial thrombolysis”. The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0–1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. Results: Seven RCTs and 9 cohort studies with a total of 6, 258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0–1, RR: 1.24, 95\% CI: 1.12–1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95\% CI: 1.04–1.32). Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0–1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.",

keywords = "Acute ischemic stroke, Intra-arterial thrombolysis, Large vessel occlusion, Meta-analysis, Thrombectomy",

author = "Lue Chen and Qiqi Huo and Qi Wei and Nguyen, \{Thanh N.\} and Abdalkader, \{Mohamad K.\} and Shunfu Jiang and Min Luo and Yu Jing and Lanlan Yang and Shuang Wang and Huiping Jiang and Shiyu Wen and Minyue Sun and Wei Huang and Shaotong Chen and Jian Yi and Guangxiong Yuan and Hongfei Sang and Yang, \{Qing Wu\} and Nongyan Wang and Zhongming Qiu and Duolao Wang and Campbell, \{Bruce C.V.\} and Yufeng Tang",

note = "Publisher Copyright: {\textcopyright} 2025 S. Karger AG, Basel",

year = "2025",

month = jul,

day = "29",

doi = "10.1159/000547442",

language = "English",

pages = "1--13",

journal = "Cerebrovascular Diseases",

issn = "1015-9770",

publisher = "S. Karger AG",

}

Chen, L, Huo, Q, Wei, Q, Nguyen, TN, Abdalkader, MK, Jiang, S, Luo, M, Jing, Y, Yang, L, Wang, S, Jiang, H, Wen, S, Sun, M, Huang, W, Chen, S, Yi, J, Yuan, G, Sang, H, Yang, QW, Wang, N, Qiu, Z, Wang, D, Campbell, BCV & Tang, Y 2025, 'The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis', Cerebrovascular Diseases, pp. 1-13. https://doi.org/10.1159/000547442

TY - JOUR

T1 - The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

AU - Chen, Lue

AU - Huo, Qiqi

AU - Wei, Qi

AU - Nguyen, Thanh N.

AU - Abdalkader, Mohamad K.

AU - Jiang, Shunfu

AU - Luo, Min

AU - Jing, Yu

AU - Yang, Lanlan

AU - Wang, Shuang

AU - Jiang, Huiping

AU - Wen, Shiyu

AU - Sun, Minyue

AU - Huang, Wei

AU - Chen, Shaotong

AU - Yi, Jian

AU - Yuan, Guangxiong

AU - Sang, Hongfei

AU - Yang, Qing Wu

AU - Wang, Nongyan

AU - Qiu, Zhongming

AU - Wang, Duolao

AU - Campbell, Bruce C.V.

AU - Tang, Yufeng

PY - 2025/7/29

Y1 - 2025/7/29

N2 - Abstract – Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms “stroke”, “thrombectomy”, “intra-arterial thrombolysis”. The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0–1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. Results: Seven RCTs and 9 cohort studies with a total of 6, 258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0–1, RR: 1.24, 95% CI: 1.12–1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04–1.32). Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0–1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.

AB - Abstract – Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms “stroke”, “thrombectomy”, “intra-arterial thrombolysis”. The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0–1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. Results: Seven RCTs and 9 cohort studies with a total of 6, 258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0–1, RR: 1.24, 95% CI: 1.12–1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04–1.32). Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0–1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.

KW - Acute ischemic stroke

KW - Intra-arterial thrombolysis

KW - Large vessel occlusion

KW - Meta-analysis

KW - Thrombectomy

U2 - 10.1159/000547442

DO - 10.1159/000547442

M3 - Comment/debate

C2 - 40730135

AN - SCOPUS:105026612082

SN - 1015-9770

SP - 1

EP - 13

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

ER -

The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Abstract

Keywords

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