Intra-Arterial Alteplase After Successful Endovascular Reperfusion in Acute Stroke

作者：Aoming Jin, Bing Sun, Chengbo Dai, Hongbing Chen, Hongyu Qiao, Jinsong You, Kangning Chen, Shuo Wang, Weihua Deng, Xu Tong, Yueqi Zhu, Zhong Ji, Xinguang Yang, Xiongjun He, Yongteng Xu, Dong Pan, Kaifeng Li, Yanting Chen, Yingying Zhu, Yuesong Pan, Tingyu Yi, Min Zhang, Huiyuan Peng, Weidong Huang, D. Li, Jiyun Feng, Junbin Chen, Weiheng Lu, Bin Liao, Yituan Xie, Baogong Liao, Lei Yang, L.Q. Tang, Bin Han, Yanchao Liu, Peijian Lin, Jixing Chen, Yanling Liang, Di Li, Guohu Weng, Hanning Huang, Hao Li, Chaoqun Li, Zhiqiang Peng, Hongzhuang Li, Baixuan He, Ruiqi Xue, Mingyi Bao, Haoyang Sun, Hongbiao Hou, Hongxing Zhou, Yi-Bin Xiao, Jie Li, Wanzhou Zhang, Xi Chen, Wei Yan, Yaxuan Pi, Zhenhong Deng, J Wang, Dongshu Xie, Mengqi Liu, Honghong Li, Qingxia Peng, Wenli Fang, Xuejing Lin, Ziyi Chen, Haiwei Li, Yuxi Lin, Queran Lin, Songhua Xiao, Zhongrong Miao, Duolao Wang, Thanh N. Nguyen, Raul G. Nogueira, Yajie Liu, Yamei Tang, PEARL investigators · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.16876 · 被引用次数：17 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Traumatic Brain Injury and Neurovascular Disturbances

Importance: Functional outcomes in patients with acute ischemic stroke due to large-vessel occlusion who undergo thrombectomy remain suboptimal, and the benefits of intra-arterial alteplase after thrombectomy remain uncertain. Objective: To investigate whether treatment with intra-arterial alteplase after successful endovascular reperfusion improves functional outcomes among patients with acute, anterior-circulation, large-vessel occlusion stroke. Design, Setting, and Participants: This multicenter, randomized clinical trial recruited patients with anterior-circulation, large-vessel occlusion stroke within 24 hours of symptom onset who achieved successful reperfusion (expanded Thrombolysis in Cerebral Infarction scale score of ≥2b50) after thrombectomy. Guideline-based intravenous thrombolysis was allowed. Patients were randomized between August 1, 2023, and October 16, 2024, and the trial was conducted at 28 hospitals in China. Final follow-up occurred on January 7, 2025. Interventions: Intra-arterial alteplase treatment (n = 164) with 0.225 mg/kg (maximum dose of 20 mg) vs standard treatment (n = 160). Main Outcomes and Measures: The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days (score range, 0 [no symptoms] to 6 [death]; a score of 0 or 1 indicates an excellent outcome). The safety outcomes included symptomatic intracranial hemorrhage within 36 hours of randomization, all-cause mortality within 90 days, and any intra...