SynthesisJournal of neurology2026
Effects of thrombus migration on endovascular treatment outcomes in patients with ischemic stroke: a systematic review and meta-analysis.
Synthesis in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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18 authors.
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Abstract
backgroundStroke is the world's second-leading cause of death, with ischemic events accounting for nearly 9 of 10 cases. Rapid endovascular treatment (EVT) is now standard, yet the benefit of giving intravenous tPA beforehand ("bridging therapy") remains uncertain. One reason: tPA often shifts the clot distally-thrombus migration (TM)-a phenomenon seen in roughly one-fifth of large-vessel strokes that can complicate the procedure but has also been linked to better outcomes. This study evaluates how TM influences clinical outcomes, aiming to clarify whether tPA adds value in patients who receive EVT.
methodsA comprehensive literature search was conducted across various databases until April 2025 to identify relevant articles. The quality was assessed using the NOS tool and the analysis was performed using RevMan 5 software. Primary outcomes of interest were favorable functional outcomes (modified Rankin Scale score 0-2) and mortality 90 days after stroke.
resultsThirteen studies (n = 6,198 patients) were identified fulfilling our research question. Thrombus migration was significantly associated with favourable neurological outcomes (mRS 0-2) at 90 days (OR = 1.43; P = 0.025). TM showed no significant impact on other outcomes, including 90-day mortality (OR = 0.86; P = 0.15), symptomatic intracranial hemorrhage (sICH) (OR = 1.12; P = 0.54), any ICH (OR = 1.25; P = 0.4), NIHSS change at discharge (MD = 0.36; P = 0.18) and successful reperfusion rates (TICI 2b-3) (OR = 0.69; P = 0.0686).
conclusionsThrombus migration during mechanical thrombectomy was associated with better 90-day functional outcomes. Although thrombus migration might affect complete revasculrization, it may offer clinical benefits by restoring blood flow to larger brain territories.
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