Key result
Adjunctive intra-arterial alteplase after successful EVT improves functional independence ~48% without increasing sICH or mortality.
Why the study?
Evidence on adjunctive thrombolytics after successful endovascular treatment in acute ischemic stroke remains limited, particularly regarding quality of life.
Do adjunctive thrombolytics improve quality of life, functional independence, and safety in patients with acute ischemic stroke following successful endovascular treatment?
Meta-Analysis (n=2,446)
Do adjunctive thrombolytics improve quality of life, functional independence, and safety in patients with acute ischemic stroke following successful endovascular treatment?
Effect estimate: SMD 0.17 (95% CI -0.04-0.37)
p-value: p=0.11
Intra-arterial thrombolytics after successful EVT in acute ischemic stroke may improve functional independence and quality of life without increasing the risk of symptomatic intracranial hemorrhage or mortality.
No QoL benefit with tenecteplase versus alteplase; leaves open whether modest gains justify switching agents in stroke care.
Background and aims Evidence on adjunctive thrombolytics after successful endovascular treatment (EVT) in acute ischemic stroke remains limited, particularly regarding quality of life. This meta-analysis assesses their impact on quality of life, functional independence, and safety. Methods A database search was conducted up to December 2025, including 12 studies (9 RCTs, 3 non-RCTs) comprising 2,446 patients with successful post-EVT reperfusion. Main outcomes: EuroQol-5 Dimensions 5 Levels (EQ-5D-5L) at 90 days, EuroQol Visual Analog Scale (EQ-VAS) at 90 days, Barthel Index 95-100 at 90 days, mRS 0-1 at 90 days, symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Results At 90 days, EQ-VAS showed a clinically relevant improvement favoring the experimental group (SMD=0.17, IC95% -0.04-0.37, p=0.11; >10 point MCID), whereas EQ-5D-5L (SMD=0.01, CI95% -0.10-0.11, p=0.89, I2=0%) and Barthel Index 95-100 (RR=1.13, IC95% 0.89-1.43, p=0.32) showed no significant differences. Subgroup analysis revealed a benefit in achieving mRS 0–1 with alteplase (RR = 1.48, p = 0.001) and tenecteplase (RR = 1.18, p = 0.06), with no safety concerns regarding sICH (RR = 1.15, 95% CI 0.80–1.67, p = 0.45) or mortality (RR = 0.99, 95% CI 0.83–1.18, p = 0.91). Intra-arterial thrombolytics after successful EVT significantly improve functional independence (mRS 0–1) without increasing sICH or mortality, with favorable signals in patient-reported quality of life. Agent-specific subgroup analyses support personalized selection, and large randomized trials are needed to confirm this “micro-reperfusion” strategy in stroke recovery. Conflict of interest Amiel Armando Aragon Cortes. Nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results Figure 3 - belongs to Results Figure 4 - belongs to Results
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Cortes et al. (2026) conducted a meta-analysis in Acute ischemic stroke (n=2,446). Adjunctive intra-arterial thrombolytics vs. No adjunctive thrombolytics was evaluated on EuroQol Visual Analog Scale (EQ-VAS) at 90 days (SMD 0.17, 95% CI -0.04-0.37, p=0.11). Adjunctive intra-arterial thrombolytics after successful EVT improved functional independence with alteplase (RR 1.48, p=0.001) without increasing sICH (RR 1.15, p=0.45) or mortality.
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