Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke

作者：Chang Liu, Changwei Guo, Fengli Li, Nizhen Yu, Jiacheng Huang, Zhouzhou Peng, Weilin Kong, Jiaxing Song, Xiang Liu, Shitao Fan, Chengsong Yue, Boyu Chen, Chong Zheng, Xingyun Yuan, Jian Sheng, Youlin Wu, Bo Sun, Zengqiang Zhao, Minzhen Zhu, Ling Han, Qiang Shi, Zhongbin Xia, Xianjin Shang, Fengguang Li, Rongzong Li, Feixue Yue, Shunfu Jiang, Dengwen Song, Min Song, Yuanjun Shan, Chawen Ding, Yao Li, Yong Yang, Junbin Chen, Wencheng He, Feibao Pan, Wensheng Zhang, Tieying Cai, Shibo Han, Wei Li, Gongbo Li, Gong Chen, Liping Huang, Cheng Huang, Duolao Wang, Johannes Kaesmacher, Thanh N. Nguyen, Raul G. Nogueira, Jeffrey L. Saver, Wenjie Zi, Yangmei Chen, Qingwu Yang, POST-UK investigators, Tao Qiu, Yihong Huang, Dai Zheng, Zhongyong Peng, Sizhi Tang, Chuang Li, Rongtong Li, Yongtao Guo, Chaoxiong Shen, Xiurong Zhu, Yugang Wang, Lei Zhang, Haitao Guan, Tao Xu, Jie Yang, Linyu Li, Dahong Yang, Jinfu Ma, Xu Xu, Xiaolei Shi, Shihai Yang, Wenzhe Sun, Zhi‐Xi Wang, Shuyu Jiang, Zhiyuan Wang · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2024.23480 · 被引用次数：83 · 研究领域：Acute Ischemic Stroke Management、Blood Coagulation and Thrombosis Mechanisms、Cerebrovascular and Carotid Artery Diseases

Importance: Persisting or new thrombi in the distal arteries and the microcirculation have been reported to limit the benefits of successful endovascular thrombectomy for patients with acute ischemic stroke. It remains uncertain whether intra-arterial thrombolysis by urokinase following near-complete to complete reperfusion by thrombectomy improves outcomes among patients with ischemic stroke due to large vessel occlusion. Objective: To assess the efficacy and adverse events of intra-arterial urokinase after near-complete to complete reperfusion by thrombectomy for acute ischemic stroke due to large vessel occlusion. Design, Setting, and Participants: This investigator-initiated, randomized, open-label, blinded-end point trial was implemented at 35 hospitals in China, enrolling 535 patients with proximal intracranial large vessel occlusion presenting within 24 hours of time last known well, who achieved near-complete or complete reperfusion by endovascular thrombectomy and did not receive intravenous thrombolysis prior to the procedure. Recruitment took place between November 15, 2022, and March 29, 2024, with final follow-up on July 4, 2024. Interventions: Eligible patients were randomly assigned to the intra-arterial urokinase group (a single dose of intra-arterial 100 000 IU urokinase injected in the initial target territory; n = 267) or control group (without intra-arterial thrombolysis; n = 267). Main Outcomes and Measures: The primary efficacy outcome was the percentage...