SynthesisTranslational stroke research2021
Efficacy and Safety of Intravenous rtPA in Ischemic Strokes Due to Small-Vessel Occlusion: Systematic Review and Meta-Analysis.
Synthesis in Translational stroke research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled 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.
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
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Early neurological deterioration in acute lacunar ischemic stroke: Systematic review of incidence, mechanisms, and prospects for treatment.International journal of stroke : official journal of the International Stroke Society · 2025Pooled it
- Software with artificial intelligence-derived algorithms for analysing CT brain scans in people with a suspected acute stroke: a systematic review and cost-effectiveness analysis.Health technology assessment (Winchester, England) · 2024Pooled it
- Meta-Analysis of the Effectiveness and Safety of Intravenous Thrombolysis in Patients with Acute Cerebral Infarction.Computational and mathematical methods in medicine · 2021Pooled it
- Rethinking the Role of CT Perfusion in IVT Decision-Making in Acute Ischemic Stroke.Clinical neuroradiology · 2026Article
- Intravenous thrombolysis versus early antiplatelet therapy in acute ischaemic stroke with small artery occlusion.Stroke and vascular neurology · 2026Observational
- Catechins in stroke: multi-target mechanisms, preclinical evidence, and translational challenges.Frontiers in pharmacology · 2026Review
- Neuroangiogenesis potential of mesenchymal stem cell extracellular vesicles in ischemic stroke conditions.Cell communication and signaling : CCS · 2025Review
- Outcomes and risk factors for functional prognosis at 3 months after intravenous thrombolysis with r-tPA in patients with acute ischemic stroke: a retrospective cohort study.Thrombosis journal · 2025Article
- Efficacy of intravenous thrombolysis in treating cortical and lacunar strokes: analysis from the Qatar Stroke Registry in a multi-ethnic population.BMJ neurology open · 2025Article
- Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke.Frontiers in neurology · 2024Article
- Cerebral small vessel disease and intracranial bleeding risk: Prognostic and practical significance.International journal of stroke : official journal of the International Stroke Society · 2023Review
- Fibrin-Targeted Nanoparticles for Finding, Visualizing and Characterizing Blood Clots in Acute Ischemic Stroke.Pharmaceutics · 2022Article
- Ten Years and Counting: a Celebration of the 10th Anniversary of Translational Stroke Research.Translational stroke research · 2021Article
- Levels of Fibrin Degradation Products at Admission With Acute Ischemic Stroke Correlate With the NIH Stroke Scale Score 1 h After Intravenous Thrombolysis.Frontiers in neurology · 2021Article
- New Remote Cerebral Microbleeds on T2Frontiers in neurology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Intravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0-1 and 0-2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29-1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31-2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76-28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%-1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.
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