{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:08:58Z","timestamp":1791886138709,"version":"4.3.4"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"S0317167125103545_as1\">\n                    <jats:title>Background and purpose:<\/jats:title>\n                    <jats:p>Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167125103545_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b\u20133). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0\u20131), functional independence (mRS 0\u20132) and recovery without any disability (mRS 0) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (ICH), any ICH and death. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167125103545_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Seven RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      = 2,130; 2022\u20132025) were included. IA thrombolytic drugs used were alteplase, tenecteplase and urokinase with doses ranging from 10 % to 50% of recommended IV dosage. IA thrombolysis significantly improved excellent functional outcome (mRS 0\u20131: OR 1.45, 95% CI 1.19\u20131.76) and recovery without any disability (mRS 0: OR 1.34, 95% CI 1.09\u20131.64), without safety risks (symptomatic ICH: 5.05% with IA thrombolytics vs. 4.49% in standard). Paradoxically, there was no difference in functional independence (mRS 0\u20132) (OR 1.09, 95% CI 0.99\u20131.20). Additionally, tenecteplase or alteplase at doses equivalent to 25% or 50% of recommended IV dosage significantly improved excellent functional outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167125103545_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>IA thrombolysis offered immediately following EVT with successful reperfusion improved excellent functional outcome and recovery without disability at 90 days with an acceptable safety profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/cjn.2025.10354","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T02:49:03Z","timestamp":1752547743000},"page":"640-648","source":"Crossref","is-referenced-by-count":10,"title":["Adjunctive Intraarterial Thrombolysis after Thrombectomy in Large Vessel Occlusion Stroke: A Meta-Analysis of RCTs"],"prefix":"10.1017","volume":"53","author":[{"given":"Mohammed A.","family":"Almekhlafi","sequence":"first","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6112-2939","authenticated-orcid":false,"given":"Hyungjong","family":"Park","sequence":"additional","affiliation":[{"name":"Keimyung University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishita","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Manitoba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8455-8201","authenticated-orcid":false,"given":"Ronda","family":"Lun","sequence":"additional","affiliation":[{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4042-4735","authenticated-orcid":false,"given":"Umberto","family":"Pensato","sequence":"additional","affiliation":[{"name":"IRCCS"},{"name":"Humanitas University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7263-8474","authenticated-orcid":false,"given":"Katrina Hannah Dizon","family":"Ignacio","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0029-6764","authenticated-orcid":false,"given":"Johanna M.","family":"Ospel","sequence":"additional","affiliation":[{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-2070","authenticated-orcid":false,"given":"Aravind","family":"Ganesh","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"Hotchkiss Brain Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Alshamrani","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"King Faisal Specialist Hospital and Research Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Demchuk","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"Hotchkiss Brain Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":false,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"Hotchkiss Brain Institute"},{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"University of Calgary"},{"name":"Hotchkiss Brain Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"S0317167125103545_ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"S0317167125103545_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.23480"},{"key":"S0317167125103545_ref16","article-title":"Intra-arterial tenecteplase for acute stroke after successful endovascular therapy. The ANGEL-TNK randomized clinical trial","author":"Miao","journal-title":"JAMA."},{"key":"S0317167125103545_ref2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.029212"},{"key":"S0317167125103545_ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.1645"},{"key":"S0317167125103545_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.017"},{"key":"S0317167125103545_ref3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.038466"},{"key":"S0317167125103545_ref14","article-title":"Intra-arterial tenecteplase after successful reperfusion in large vessel occlusion stroke: A randomized clinical trial","author":"Hou","journal-title":"JAMA Neurol"},{"key":"S0317167125103545_ref12","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-25"},{"key":"S0317167125103545_ref22","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.703258"},{"key":"S0317167125103545_ref19","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010049"},{"key":"S0317167125103545_ref17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-091059"},{"key":"S0317167125103545_ref1","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2012.139"},{"key":"S0317167125103545_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.06.015"},{"key":"S0317167125103545_ref13","doi-asserted-by":"publisher","DOI":"10.3758\/BF03206394"},{"key":"S0317167125103545_ref9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-080489"},{"key":"S0317167125103545_ref23","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.045754"},{"key":"S0317167125103545_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.23466"},{"key":"S0317167125103545_ref15","unstructured":"15. ISC 2025 Session Report: Intra-Arterial Tenecteplase After Successful Recanalization Improves Neurological Outcomes. 2025."},{"key":"S0317167125103545_ref4","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012112"},{"key":"S0317167125103545_ref21","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"S0317167125103545_ref6","first-page":"e12823_12027","article-title":"Adjunctive intra-arterial tenecteplase following mechanical thrombectomy. (ALLY) pilot trial","volume":"3","author":"Alhajala","year":"2023","journal-title":"Stroke Vasc Interv Neurol"},{"key":"S0317167125103545_ref20","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26474"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167125103545","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:57:37Z","timestamp":1789138657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167125103545\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["S0317167125103545"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2025.10354","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]}}}