Background and aims We aimed to evaluate the efficacy of adjunctive intra-arterial alteplase after endovascular reperfusion in acute ischemic patients without intravenous thrombolysis. Methods This is a post hoc analysis of the intra-arterial alteplase after successful endovascular reperfusion in acute stroke trial (PEARL, NCT05856851). From 324 randomized patients in the PEARL trial, 189 patients without intravenous thrombolysis were included in this post hoc subgroup analysis. The primary outcome was the proportion of patients with a modified Rankin Scale score (mRS) of 0 or 1 at 90 days. The safety outcomes included symptomatic intracranial hemorrhage (sICH) within 36 hours, any intracranial hemorrhage (ICH) within 36 hours, and all-cause mortality within 90 days. Results Of the 189 patients, 95 were assigned to intra-arterial alteplase group and 94 to the standard treatment group. The proportion of patients with a mRS of 0 or 1 at 90 days was 43.2% in the intra-arterial alteplase group vs 22.6% in the standard treatment group (adjusted risk ratio [RR], 1.86 [95% CI, 1.19-2.91]; P = 0.007). ICH within 36 hours (32.6% vs 30.9%, adjusted RR, 1.044 [95% CI, 0.681-1.6]; P = 0.843), sICH within 36 hours (5.3% vs 5.3%, adjusted RR, 0.931 [95% CI, 0.277-3.129]; P = 0.908), and all-cause mortality within 90 days (adjusted hazard ratio, 0.995 [95% CI, 0.487-2.04]; P = 1.000) did not show significant difference between the two groups. Conclusions Among acute ischemic stroke patients due to large vessel occlusion who did not receive intravenous thrombolysis, adjunctive intra-arterial alteplase after successful endovascular reperfusion was associated with better functional outcomes at 90 days.
No takes yet. Share an insight, caveat, or question.
Deng et al. (2026) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: