ArticleJournal of neurointerventional surgery2023
Benefit and risk of intravenous alteplase in patients with acute large vessel occlusion stroke and low ASPECTS.
Article in Journal of neurointerventional surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- To Bridge or Not to Bridge? A Meta-Analysis of Intravenous Thrombolysis Before Thrombectomy in Large Ischemic Core Strokes.Brain and behavior · 2025Pooled it
- Endovascular thrombectomy with or without intravenous alteplase in large-core ischemic stroke: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Pooled it
- Effectiveness and safety of bridging therapy and endovascular therapy in patients with large cerebral infarctions: from ANGEL-ASPECT.Stroke and vascular neurology · 2025Trial
- The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.International journal of stroke : official journal of the International Stroke Society · 2025Trial
- Bridging Thrombolysis before Endovascular Therapy Improves Functional Outcomes in Medium-Large Core Stroke within 4.5 Hours: A Multicenter Propensity-Matched Study.Cerebrovascular diseases extra · 2026Article
- CT perfusion ischemic core predicts PH-2 hemorrhagic transformation following intravenous alteplase bridging treatment prior to endovascular thrombectomy.Therapeutic advances in neurological disorders · 2026Article
- Hemorrhagic transformation after endovascular treatment: Baseline infarct volume is a better predictor than infarct growth rate.European stroke journal · 2026Article
- Hemorrhagic transformation after endovascular treatment: Baseline infarct volume is a better predictor than infarct growth rate.European stroke journal · 2025Article
- Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake.Stroke and vascular neurology · 2024Article
- Prediction of hemorrhagic transformation in acute ischemic stroke: a never-ending endeavor.European radiology · 2024Article
- Review
- Bridging Thrombolysis and ASPECTS in Patients With Stroke Treated With Endovascular Thrombectomy.Stroke (Hoboken, N.J.) · 2023Article
- Association Between Net Water Uptake and Functional Outcome in Patients With Low ASPECTS Brain Lesions: Results From the I-LAST Study.Neurology · 2023Observational
- Review of Current Large Core Volume Stroke Thrombectomy Clinical Trials: Controversies and Progress.Stroke (Hoboken, N.J.) · 2022Review
- Editorial: Mechanisms, Measurement, and Management of Vasogenic Edema After Stroke.Frontiers in neurology · 2022Article
Corrections and comments
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Authors and funding
21 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe benefit of best medical treatment including intravenous alteplase (IVT) before mechanical thrombectomy (MT) in patients with acute ischemic stroke and extensive early ischemic changes on baseline CT remains uncertain. The purpose of this study was to evaluate the benefit of IVT for patients with low ASPECTS (Alberta Stroke Programme Early CT Score) compared with patients with or without MT.
methodsThis multicenter study pooled consecutive patients with anterior circulation acute stroke and ASPECTS≤5 to analyze the impact of IVT on functional outcome, and to compare bridging IVT with direct MT. Functional endpoints were the rates of good (modified Rankin Scale (mRS) score ≤2) and very poor (mRS ≥5) outcome at day 90. Safety endpoint was the occurrence of symptomatic intracranial hemorrhage (sICH).
results429 patients were included. 290 (68%) received IVT and 168 (39%) underwent MT. The rate of good functional outcome was 14.4% (95% CI 7.1% to 21.8%) for patients who received bridging IVT and 24.4% (95% CI 16.5% to 32.2%) for those who underwent direct MT. The rate of sICH was significantly higher in patients with bridging IVT compared with direct MT (17.8% vs 6.4%, p=0.004). In multivariable logistic regression analysis, IVT was significantly associated with very poor outcome (OR 2.22, 95% CI 1.05 to 4.73, p=0.04) and sICH (OR 3.44, 95% CI 1.18 to 10.07, p=0.02). Successful recanalization, age, and ASPECTS were associated with good functional outcome.
conclusionsBridging IVT in patients with low ASPECTS was associated with very poor functional outcome and an increased risk of sICH. The benefit of this treatment should therefore be carefully weighed in such scenarios. Further randomized controlled trials are required to validate our findings.
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