Intra-Arterial Alteplase After Successful Endovascular Reperfusion in Acute Stroke

Does intra-arterial alteplase after successful reperfusion by mechanical thrombectomy improve functional outcomes in patients with acute, anterior-circulation, large-vessel occlusion stroke?In this randomized clinical trial that included 324 patients, 44.8% of patients in the intra-arterial alteplase group achieved a modified Rankin Scale score of 0 or 1 at 90 days, indicating an excellent outcome, compared with 30.2% in the standard treatment group. This difference was statistically significant (adjusted risk ratio, 1.45).Among patients with acute, anterior-circulation, large-vessel occlusion stroke who achieved successful endovascular reperfusion by mechanical thrombectomy, intra-arterial alteplase resulted in a higher likelihood of excellent functional outcome at 90 days.

Corresponding Authors: Yamei Tang, MD, PhD, Sun Yat-sen University, 107 Yan Jiang Xi Rd, Guangzhou 510120, China (tangym@mail.sysu.edu.cn); Raul G. Nogueira, MD, University of Pittsburgh School of Medicine, UPMC Stroke Institute, 200 Lothrop St, Pittsburgh, PA 15213 (nogueirarg@upmc.edu).

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