Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion
IntroductionFor acute ischemic stroke (AIS) with large vessel occlusion (LVO), the currently established treatment strategy of combined intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) is not sufficiently effective in all patients. Intra-arterial thrombolysis (IAT) as an adjunct to...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1560045/full |
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| author | Norma J. Diel Kai Bernhard Woelk Anne Mrochen Oliver Posner Andre Worm Omar Alhaj Omar Christian Claudi Patrick Schramm Tobias Struffert Hagen B. Huttner |
| author_facet | Norma J. Diel Kai Bernhard Woelk Anne Mrochen Oliver Posner Andre Worm Omar Alhaj Omar Christian Claudi Patrick Schramm Tobias Struffert Hagen B. Huttner |
| author_sort | Norma J. Diel |
| collection | DOAJ |
| description | IntroductionFor acute ischemic stroke (AIS) with large vessel occlusion (LVO), the currently established treatment strategy of combined intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) is not sufficiently effective in all patients. Intra-arterial thrombolysis (IAT) as an adjunct to IVT/EVT may improve outcomes but may also increase the rate of hemorrhagic complications.MethodsThis observational study analyzed data from the Giessen Stroke Registry (GIST; NCT05295862) between May 2022 and June 2024. Patients with AIS and LVO who received both IVT and EVT were included. A subset of patients received additional IAT (triple treatment, TT). Using 1:1 propensity score matching, 33 TT patients were compared with 33 controls who received only IVT + EVT. Primary outcomes were hemorrhagic complications (ECASS classification), and secondary outcomes included reperfusion rates, ASPECTS scores, 7-day mortality, and functional outcomes.ResultsBaseline characteristics were balanced between the TT and the control group. The primary outcome was not significantly different with a rate of hemorrhagic complications of 3/33 (9%) in the TT group and 4/33 (12%) in the control group (OR 0.725, 95% CI 0.149–3.525). Secondary outcomes showed no significant differences with respect to rates of successful reperfusion, ASPECTS scores or 7-day mortality rates between TT and the control group.ConclusionTriple treatment (IVT, EVT, and IAT) did not significantly improve clinical outcomes compared to IVT and EVT alone. However, TT was safe without signs of increased bleeding complications. TT should not be routinely used until further evidence verifies safety and substantiates a possible benefit in specific patient populations. |
| format | Article |
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| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-28cb3351ce234efeb4cb13f8d6b945cd2025-08-20T03:21:46ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-05-011610.3389/fneur.2025.15600451560045Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusionNorma J. Diel0Kai Bernhard Woelk1Anne Mrochen2Oliver Posner3Andre Worm4Omar Alhaj Omar5Christian Claudi6Patrick Schramm7Tobias Struffert8Hagen B. Huttner9Department of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neuroradiology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neuroradiology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyDepartment of Neurology, Justus-Liebig-University Hospital Giessen, Giessen, GermanyIntroductionFor acute ischemic stroke (AIS) with large vessel occlusion (LVO), the currently established treatment strategy of combined intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) is not sufficiently effective in all patients. Intra-arterial thrombolysis (IAT) as an adjunct to IVT/EVT may improve outcomes but may also increase the rate of hemorrhagic complications.MethodsThis observational study analyzed data from the Giessen Stroke Registry (GIST; NCT05295862) between May 2022 and June 2024. Patients with AIS and LVO who received both IVT and EVT were included. A subset of patients received additional IAT (triple treatment, TT). Using 1:1 propensity score matching, 33 TT patients were compared with 33 controls who received only IVT + EVT. Primary outcomes were hemorrhagic complications (ECASS classification), and secondary outcomes included reperfusion rates, ASPECTS scores, 7-day mortality, and functional outcomes.ResultsBaseline characteristics were balanced between the TT and the control group. The primary outcome was not significantly different with a rate of hemorrhagic complications of 3/33 (9%) in the TT group and 4/33 (12%) in the control group (OR 0.725, 95% CI 0.149–3.525). Secondary outcomes showed no significant differences with respect to rates of successful reperfusion, ASPECTS scores or 7-day mortality rates between TT and the control group.ConclusionTriple treatment (IVT, EVT, and IAT) did not significantly improve clinical outcomes compared to IVT and EVT alone. However, TT was safe without signs of increased bleeding complications. TT should not be routinely used until further evidence verifies safety and substantiates a possible benefit in specific patient populations.https://www.frontiersin.org/articles/10.3389/fneur.2025.1560045/fullacute ischemic strokeintravenous thrombolysisendovascular treatmentintraarterial thrombolysismechanical thrombectomy |
| spellingShingle | Norma J. Diel Kai Bernhard Woelk Anne Mrochen Oliver Posner Andre Worm Omar Alhaj Omar Christian Claudi Patrick Schramm Tobias Struffert Hagen B. Huttner Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion Frontiers in Neurology acute ischemic stroke intravenous thrombolysis endovascular treatment intraarterial thrombolysis mechanical thrombectomy |
| title | Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| title_full | Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| title_fullStr | Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| title_full_unstemmed | Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| title_short | Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| title_sort | safety and efficacy of add on intra arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion |
| topic | acute ischemic stroke intravenous thrombolysis endovascular treatment intraarterial thrombolysis mechanical thrombectomy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1560045/full |
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