Among patients with acute ischemic stroke due to large vessel occlusion who had successful recanalization after endovascular thrombectomy, does adjunctive intra-arterial alteplase improve functional outcomes compared with thrombectomy alone?
Among patients with acute ischemic stroke due to large vessel occlusion who had successful recanalization after endovascular thrombectomy, does adjunctive intra-arterial alteplase improve functional outcomes compared with thrombectomy alone?
CHOICE-2
Adjunctive Intra-Arterial Alteplase After Successful Thrombectomy for Acute Ischemic Stroke: The CHOICE-2 Randomized Clinical Trial
Bottom Line: In this multicenter Spanish RCT (n=440) of anterior-circulation LVO stroke with successful thrombectomy (eTICI 2b50-3), adjunctive intra-arterial alteplase (0.225 mg/kg, max 20 mg) increased 90-day mRS 0-1 from 42.5% to 57.5% (adjusted RD 15.0%, 95% CI 5.7-24.3; P=.002; NNT ≈ 7). Residual hypoperfusion at 36 h was halved (28.6% vs…