BRIEF RESEARCH REPORT article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1560045
Safety and efficacy of add-on intra-arterial thrombolysis after intravenous thrombolysis and mechanical thrombectomy in patients with ischemic stroke and cerebral vessel occlusion
Provisionally accepted
Norma J. Diel1Kai Bernhard Woelk2Anne Mrochen1Oliver Posner1André Worm1Omar Alhaj Omar1Christian Claudi1Patrick Schramm1Tobias Struffert2
Hagen B. Huttner1*- 1Clinic for Neurology, Faculty of Medicine, University of Giessen, Giessen, Germany
- 2Department of Neuroradiology, Justus Liebig University Giessen, Giessen, Germany
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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.Methods This 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.Results Baseline 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.Conclusion Triple 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.
Keywords: Acute ischemic stroke1, Intravenous thrombolysis2, endovascular treatment3, intraarterial thrombolysis4, mechanical thrombectomy5
Received: 13 Jan 2025; Accepted: 13 May 2025.
Copyright: © 2025 Diel, Woelk, Mrochen, Posner, Worm, Alhaj Omar, Claudi, Schramm, Struffert and Huttner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hagen B. Huttner, Clinic for Neurology, Faculty of Medicine, University of Giessen, Giessen, 35390, Germany
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