IAT-TOP
(2025)Objective
To evaluate whether adjunctive intra-arterial alteplase improves outcomes after successful posterior circulation thrombectomy
Study Summary
• Trial stopped early for futility after 247 patients
• No difference in mRS 0-2 at 90 days (41.9% vs 46.7%, p=0.55)
• IA alteplase was safe but provided no functional benefit
• No difference in mRS 0-2 at 90 days (41.9% vs 46.7%, p=0.55)
• IA alteplase was safe but provided no functional benefit
Intervention
Intra-arterial alteplase 0.225 mg/kg (infused over 15 min distal to PICA origin) vs Best medical treatment
Inclusion Criteria
Basilar or vertebral artery occlusion without anterograde flow to basilar, pc-ASPECTS 6–10, post-procedural eTICI ≥2b50, ≤2 thrombectomy passes
Study Design
Arms: IA alteplase + standard care vs Standard care alone
Patients per Arm: 125 IA alteplase, 122 control
Outcome
• Primary: mRS 0–2 at 90 days: 41.9% vs 46.7% (RR 0.90, 95% CI 0.68–1.19, p=0.55)
• Secondary (eTICI change, mRS 0–1, early improvement): All non-significant
• Safety: No difference in ICH (mild/moderate/severe) or 90-day mortality
• Secondary (eTICI change, mRS 0–1, early improvement): All non-significant
• Safety: No difference in ICH (mild/moderate/severe) or 90-day mortality