Abstract Number: Esoc2026ys63 Impact on Quality of Life, Efficacy, and Safety of Thrombolysis Following Successful Endovascular Therapy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract 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