Evidence map›Paper›PMID 40402426›Full record

SynthesisActa neurologica Belgica2026

Endovascular thrombectomy plus intravenous thrombolysis versus endovascular thrombectomy alone for large ischemic stroke.

Mohamed Elfil, Abdallah Abbas, Hayes Fountain, Ebrahem Salah Abdul-Hamid, Mohammad Aladawi, Zaid Najdawi, Ahmed Elmashad, Hazem S Ghaith, Giana Dawod, Iman Moeini-Naghani and 8 more

Abstract readMeta-AnalysisSystematic Review
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In one paragraph

Synthesis in Acta neurologica Belgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Mohamed ElfilDepartment of Neurology, University of Miami/Jackson Health System, Miami, FL, USA.
Abdallah AbbasFaculty of Medicine, Al-Azhar University, Damietta, Egypt.
Hayes FountainMiller School of Medicine, University of Miami, Miami, FL, USA.
Ebrahem Salah Abdul-HamidFaculty of Medicine, Al-Azhar University, Damietta, Egypt.
Mohammad AladawiDepartment of Neurology, University of Alabama, Birmingham, AL, USA.
Zaid NajdawiDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Ahmed ElmashadDepartment of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Hazem S GhaithFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Giana DawodDepartment of Neurology, Weill Cornell Medicine, Manhattan, NY, USA.
Iman Moeini-NaghaniDepartment of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Suhail Abdulla AlRuknDepartment of Neurology, Rashid Hospital, Dubai, United Arab Emirates.
Chaitanya MedicherlaDepartment of Neurology, Westchester Medical Center, Valhalla, NY, USA.
Hosam AljehaniDepartment of Interventional Neuroradiology, King Fahd Hospital of the University, Imam, Saudi Arabia.
Priyank KhandelwalDepartment of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Gurmeen KaurDepartment of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Mohammad El-GhanemDepartment of Clinical Sciences, University of Houston, HCA Houston Healthcare/HCA Northwest Medical Center, Houston, TX, USA.
Chirag D GandhiDepartment of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Fawaz Al-MuftiDepartment of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA. Fawaz.al-mufti@wmchealth.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndovascular thrombectomy (EVT) is the gold standard for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). A few trials studied EVT in AIS-LVO with large ischemic infarcts. We investigated the impact of intravenous thrombolysis (IVT) on EVT outcomes in those patients.

methodsWe conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane Handbook of Systematic Reviews and Interventions. We searched 4 databases and performed our analysis utilizing a pooled risk ratio (RR) with a 95% confidence interval (CI).

resultsThree studies investigated EVT with and without IVT in AIS-LVO patients with large ischemic infarcts. Regarding the modified Rankin Scale (mRS) score of 0-2 at 3 months, there was a statistically significant difference favoring EVT plus IVT (RR: 1.48, 95%CI: 1.27, 1.72, P < 0.00001). In respect of mRS score of 0-3, the analysis also favored EVT plus IVT (RR: 1.25, 95%CI: 1.11, 1.41, P = 0.0003). Regarding early neurological improvement (ENI) at 24 and 36 hours, our analysis favored EVT plus IVT (RR: 1.16, 95%CI: 1.01, 1.34, P = 0.03). In terms of mortality, our analysis favored EVT plus IVT (RR: 0.88, 95%CI: 0.77, 1, P = 0.04). There was no difference between the two groups across different types of intracranial hemorrhage (ICH).

conclusionOur results showed a beneficial impact of IVT on the outcomes of EVT in AIS-LVO patients with large ischemic infarcts in terms of functional outcomes and ENI. IVT was also associated with a lower mortality rate but not with an increased risk of ICH. Larger studies are needed to corroborate such results.

Indexed as

Brain IschemiaEndovascular ProceduresFibrinolytic AgentsIschemic StrokeThrombectomyThrombolytic TherapyHumansTreatment OutcomeFibrinolytic AgentsAcute ischemic strokeEndovascular thrombectomyIntravenous thrombolysisMeta-analysis

Identifiers

PMID40402426

What OpenQuestion holds

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Registered trials

None linked

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.