Intravenous Thrombolysis for Ischemic Stroke Patients with Pituitary Neoplasms: A Nationwide Study and Scoping Review

Objective: The safety of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) patients with pituitary neoplasms is unclear. This study aims to assess IVT’s safety and efficacy in this patient population. Methods: We reviewed PubMed, Scopus, EMBASE, and Web of Science through July 2025 for reports of IVT administration in AIS patients with pituitary neoplasia. We also performed a retrospective analysis of the Nationwide Readmissions Database (NRD) from 2016 to 2022 to compare outcomes of IVT versus no IVT for AIS patients with pituitary neoplasia, and outcomes of IVT-treated AIS patients with versus without pituitary neoplasia. Outcomes of interest include post-stroke functional status, intracranial hemorrhage (ICH), mortality, and pituitary apoplexy. Multivariate regression analyses were performed to adjust for confounders. Results: The literature review identified 5 AIS patients with pituitary neoplasia, of whom 3/5 (60%) experienced intracranial hemorrhage and none developed apoplexy. In the nationwide analysis of 1,246,750 AIS patients, 1661 (0.13%) had concomitant pituitary neoplasm. Among these patients, IVT was associated with higher odds of functional independence at discharge (adjusted OR 2.46 [95%CI 1.56–3.87]), without increased risk of ICH or in-hospital death (p > 0.05). No cases of pituitary apoplexy were observed. Outcomes among all IVT-treated AIS patients did not differ between those with and without pituitary neoplasms (all p > 0.05). Interpretation: Only five cases of IVT for AIS patients with pituitary neoplasia were identified, highlighting a striking lack of clinical data. In a large U.S. cohort of AIS patients, IVT was associated with improved hospitalization outcomes without increased risk of ICH or pituitary apoplexy.