{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:09:00Z","timestamp":1791886140014,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The efficacy and safety of intra\u2010arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in large vessel occlusion strokes (LVOS) remain uncertain, with recent randomized controlled trials (RCTs) yielding conflicting results. This meta\u2010analysis aimed to assess the impact of IAT following successful EVT in patients with LVOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A comprehensive search was conducted across PubMed,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , the Cochrane Library databases, and the International Stroke Conference 2025 abstracts to identify RCTs evaluating IAT following successful EVT from January 2015 to February 2025. The primary outcome was the odds of achieving an excellent functional outcome (defined as a modified Rankin Scale [mRS]\u2009=\u20090\u20131 at 90\u2009days). Secondary outcomes included 90\u2010day functional independence (mRS\u2009=\u20090\u20132). Safety measures included symptomatic intracranial hemorrhage (sICH), and mortality at 90\u2009days. The protocol was registered in PROSPERO (CRD420250651602).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The primary pooled analysis of 6 RCTs (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091,974) showed that IAT significantly increased the likelihood of achieving excellent functional outcome at 90\u2009days (mRS\u2009=\u20090\u20131: odds ratio [OR]\u2009=\u20091.47, 95% confidence interval [CI]\u2009=\u20091.21\u20131.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with a notable effect in anterior circulation (OR\u2009=\u20091.48, 95% CI\u2009=\u20091.18\u20131.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) but not in posterior circulation LVOS (OR\u2009=\u20091.51, 95% CI\u2009=\u20090.83\u20132.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.18). Among thrombolytic drugs, alteplase was most strongly associated with favorable outcomes (mRS\u2009=\u20090\u20131: OR\u2009=\u20091.94, 95% CI\u2009=\u20091.31\u20132.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), followed by tenecteplase (OR\u2009=\u20091.43, 95% CI\u2009=\u20091.08\u20131.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). No significant safety concerns were observed, as there was no increase in the odds of sICH (OR\u2009=\u20091.15, 95% CI\u2009=\u20090.75\u20131.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.51) or 90\u2010day mortality (OR\u2009=\u20091.00, 95% CI\u2009=\u20090.79\u20131.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.99). Sensitivity analyses for all outcomes yielded consistent results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>IAT following successful EVT significantly enhances the likelihood of achieving an excellent functional outcome, particularly in anterior circulation strokes. Although the benefit in posterior circulation strokes remains uncertain, the lack of significant differences in sICH risk and mortality across thrombolytic drugs and stroke locations support the safety of IAT. ANN NEUROL 2025;98:1299\u20131314<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.70021","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T09:28:35Z","timestamp":1755077315000},"page":"1299-1314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Adjunctive\n                    <scp>Thrombolytics<\/scp>\n                    After Successful Endovascular Reperfusion: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8279-5078","authenticated-orcid":false,"given":"Mohamed F.","family":"Doheim","sequence":"first","affiliation":[{"name":"UPMC Stroke Institute, Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7393-9989","authenticated-orcid":false,"given":"Mahmoud H.","family":"Mohammaden","sequence":"additional","affiliation":[{"name":"Department of Neurology Grady Memorial Hospital, Emory University School of Medicine  Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Jumah","sequence":"additional","affiliation":[{"name":"Department of Neurology Grady Memorial Hospital, Emory University School of Medicine  Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2596-2631","authenticated-orcid":false,"given":"Qingwu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)  Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6323-2659","authenticated-orcid":false,"given":"Wenjie","family":"Zi","sequence":"additional","affiliation":[{"name":"Department of Neurology Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)  Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangmei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Chongqing Medical University  Yuzhong District People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6353-6107","authenticated-orcid":false,"given":"Yamei","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurology Sun Yat\u2010sen Memorial Hospital, Sun Yat\u2010sen University  Guangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajie","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology Shenzhen Hospital of Southern Medical University  Shenzhen People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochuan","family":"Huo","sequence":"additional","affiliation":[{"name":"Cerebrovascular Disease Department, Neurological Disease Center Beijing Anzhen Hospital, Capital Medical University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Liu","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital, Capital Medical University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurology at Melbourne Brain Center The University of Melbourne Medicine at Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongrong","family":"Miao","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Department of Neurology Beijing Tiantan Hospital, Capital Medical University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine University of Science and Technology of China  Hefei People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunrong","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine University of Science and Technology of China  Hefei People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinfeng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine University of Science and Technology of China  Hefei People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6295","authenticated-orcid":false,"given":"Liqun","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Disease Fujian Medical University Union Hospital  Fuzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo C.","family":"Haussen","sequence":"additional","affiliation":[{"name":"Department of Neurology Grady Memorial Hospital, Emory University School of Medicine  Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Medical Center, Chobanian and Avedisian School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"UPMC Stroke Institute, Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/15910199231170681"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01341-6"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01820-8"},{"key":"e_1_2_13_6_1","article-title":"Risk factors of futile recanalization following endovascular treatment in patients with large\u2010vessel occlusion: systematic review and meta\u2010analysis","volume":"2","author":"Shahid AH","year":"2022","journal-title":"Stroke Vasc Interv Neurol"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S458467"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014127"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.039476"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231180434"},{"key":"e_1_2_13_11_1","first-page":"437","article-title":"Cerebral ischemia. Ii. The no\u2010reflow phenomenon","volume":"52","author":"Ames A","year":"1968","journal-title":"Am J Pathol"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.9.1894"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000038987.62325.14"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031738"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-022-01053-0"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.01195"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231184369"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.23480"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.23466"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-080489","article-title":"Intra\u2010arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (attention\u2010ia): multicentre randomised controlled trial","volume":"388","author":"Hu W","year":"2025","journal-title":"BMJ"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.1645"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-091059"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.10800"},{"key":"e_1_2_13_24_1","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"Chandler J","year":"2019"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.ED000142"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7249.1574"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08r04484"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.2036"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048846"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2411668"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408954"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045228"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.042674"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01142-X"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60768-5"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.70021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T04:18:33Z","timestamp":1765167513000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.70021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/ana.70021"],"URL":"https:\/\/doi.org\/10.1002\/ana.70021","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]},"assertion":[{"value":"2025-02-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}