Trial reportAnnals of neurology2022
Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy.
Trial report in Annals of neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 21 papers, 4 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.
CHemical OptImization of Cerebral Embolectomy in Patients With Acute Stroke Treated With Mechanical Thrombectomy 2 (CHOICE 2 TRIAL)
Efficacy of Different Biological Treatments in Patients With Inflammatory Bowel Disease After One Year of Treatment in Upper Egypt
Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Intra-Arterial Thrombolysis Following Endovascular Recanalization for Large Vessel Occlusion Stroke: A Systematic Review and Meta-Analysis.Neurology · 2025Pooled it
- Adjunctive intra-arterial thrombolysis following successful endovascular reperfusion in acute ischemic stroke: a systematic review and meta-analysis of seven randomized controlled trials.Journal of neurology · 2025Pooled it
- Natural Evolution of Incomplete Reperfusion in Patients Following Endovascular Therapy After Ischemic Stroke.Stroke · 2025Pooled it
- Incidence, severity and impact on functional outcome of persistent hypoperfusion despite large-vessel recanalization, a potential marker of impaired microvascular reperfusion: Systematic review of the clinical literature.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2024Pooled it
- Chemical Optimization of Cerebral Embolectomy 2 (CHOICE 2) trial: study protocol.Stroke and vascular neurology · 2026Trial
- Trial
- Intra-Arterial thrombolysis after SUCCESSful angiographic recanalization in acute large-vessel occlusion stroke of the anterior circulation (IA-SUCCESS): a multicentre, randomised, clinical trial protocol.European stroke journal · 2026Article
- Revisiting Incomplete Tissue-Level Reperfusion Following Successful Thrombectomy for Acute Ischemic Stroke.Annals of neurology · 2026Review
- Safety and efficacy of intra-arterial tenecteplase for non-complete reperfusion of intracranial occlusions: Methodology of a randomized, controlled, multicenter study.European stroke journal · 2026Article
- Ischemic stroke neuroprotection revisited: translational barriers and a phase-resolved, biomarker-anchored framework.Archives of pharmacal research · 2026Review
- Thrombolysis-to-recanalization time and clinical outcomes in large-vessel occlusion patients with successful recanalization.Journal of neurology · 2025Article
- Clinical, Imaging, and Serum Biomarker Predictors of Malignant Cerebral Infarction.Journal of cardiovascular development and disease · 2025Article
- Adjunctive intra-arterial thrombolysis after thrombectomy: Findings from the RITE registry.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Effect of Thrombolytics on Delayed Reperfusion After Incomplete Thrombectomy: Target Trial Emulation.Neurology · 2025Article
- Relevance of persistent perfusion deficits on clinical outcomes after successful endovascular treatment: a prospective serial magnetic resonance study.Frontiers in neurology · 2025Article
- Microvascular reperfusion during endovascular therapy: the balance of supply and demand.Journal of neurointerventional surgery · 2024Article
- Pharmacological preclinical comparison of tenecteplase and alteplase for the treatment of acute stroke.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2024Article
- Systemic Immune-Inflammation Response is Associated with Futile Recanalization After Endovascular Treatment.Neurocritical care · 2024Article
- Thrombolytic therapy based on lyophilized platelet-derived nanocarriers for ischemic stroke.Journal of nanobiotechnology · 2024Article
- Uric Acid: A Translational Journey in Cerebroprotection That Spanned Preclinical and Human Data.Neurology · 2023Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study was undertaken to investigate whether adjunct alteplase improves brain reperfusion following successful thrombectomy.
methodsThis single-center, randomized, double-blind, placebo-controlled study included 36 patients (mean [standard deviation] = 70.8 [13.5] years old, 18 [50%] women) with large vessel occlusion undergoing thrombectomy resulting in near-normal (expanded Thrombolysis in Cerebral Infarction [eTICI] b50/67/2c, n = 23, 64%) or normal angiographic reperfusion (eTICI 3, n = 13, 36%). Seventeen patients were randomized to intra-arterial alteplase (0.225mg/kg), and 19 received placebo. At 48 hours, patients had brain perfusion/diffusion-weighted magnetic resonance imaging (MRI) and MRI-spectroscopy. The primary outcome was the difference in the proportion of patients with areas of hypoperfusion on MRI. Secondary outcomes were the infarct expansion ratio (final to initial infarction volume), and the N-acetylaspartate (NAA) peak relative to total creatine as a marker of neuronal integrity.
resultsThe prevalence of hypoperfusion was 24% with intra-arterial alteplase, and 58% with placebo (adjusted odds ratio = 0.20, 95% confidence interval [CI] = 0.04-0.91, p = 0.03). Among 14 patients with final eTICI 3 scores, hypoperfusion was found in 1 of 7 (14%) in the alteplase group and 3 of 7 (43%) in the placebo group. Abnormal brain perfusion was associated with worse functional outcome at day 90. Alteplase significantly reduced the infarct expansion ratio compared with placebo (median [interquartile range (IQR)] = 0.7 [0.5-1.2] vs 3.2 [1.8-5.7], p = 0.01) and resulted in higher NAA peaks (median [IQR] = 1.13 [0.91-1.36] vs 1.00 [0.74-1.22], p < 0.0001).
interpretationThere is a high prevalence of areas of hypoperfusion following thrombectomy despite successful reperfusion on angiography. Adjunct alteplase enhances brain reperfusion, which results in reduced expansion of the infarction and improved neuronal integrity. ANN NEUROL 2022;92:860-870.
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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 OpenQuestion graph.