{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:03:52Z","timestamp":1792623832521,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T00:00:00Z","timestamp":1748131200000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuroimaging"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Despite significant advances in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), approximately 30%\u201340% of patients experience futile recanalization. This meta\u2010analysis aimed to assess the effectiveness and safety of adjunctive intra\u2010arterial thrombolysis (IAT) following EVT in individuals with AIS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic review and meta\u2010analysis of randomized controlled trials (RCTs) that compared IAT after EVT with standard care. A literature search was conducted across multiple databases up to March 2025. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0\u20131) at 90 days, functional independence (mRS 0\u20132), and mortality rate. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six RCTs comprising 1971 patients were included. Adjunctive IAT significantly increased excellent functional outcomes at 90 days (RR\u00a0=\u00a01.24 [1.12\u20131.39], <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001), without significant improvement in functional independence (RR\u00a0=\u00a01.04 [0.96\u20131.13], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.34). The IAT group exhibited significantly higher EuroQol 5 dimensions scores (MD\u00a0=\u00a00.08 [0.03\u20130.13], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001). Mortality rates were comparable (RR\u00a0=\u00a01.01 [0.84\u20131.23], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.89). No significant differences were observed in any intracerebral hemorrhage (RR\u00a0=\u00a01.15 [1.00\u20131.33], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.08), symptomatic intracerebral hemorrhage (RR\u00a0=\u00a01.13 [0.76\u20131.68], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.53), or systemic bleeding complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adjunctive IAT following EVT significantly enhances excellent functional recovery and health\u2010related quality of life after AIS, without significantly increasing hemorrhagic complications. These findings support the consideration of IAT as a complementary strategy following mechanical thrombectomy in AIS patients who present within 24\u00a0h of symptom onset.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jon.70054","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T04:25:27Z","timestamp":1748233527000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Adjunctive Intra\u2010Arterial Thrombolysis Following Endovascular Thrombectomy in Acute Ischemic Stroke: A Meta\u2010Analysis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4976-7814","authenticated-orcid":false,"given":"Mohammed M.","family":"Al\u2010Salihi","sequence":"first","affiliation":[{"name":"Zeenat Qureshi Stroke Institute &amp; Department of Neurology University of Missouri  Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam S.","family":"Al\u2010Jebur","sequence":"additional","affiliation":[{"name":"College of Medicine University of Baghdad  Baghdad Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Neurology Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Abd","family":"Elazim","sequence":"additional","affiliation":[{"name":"Department of Neurology University of South Dakota  Sioux Falls South Dakota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhan","family":"Siddiq","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Missouri  Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4962-540X","authenticated-orcid":false,"given":"Adnan I.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Zeenat Qureshi Stroke Institute &amp; 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