Functional Benefit and Safety of Adjunctive Intra-Arterial Thrombolysis After Successful Endovascular Thrombectomy: An Updated and Cumulative Meta-Analysis of Randomized Trials

Background/Objectives: Adjunctive intra-arterial thrombolysis (IAT) after successful endovascular thrombectomy has been associated with a higher probability of excellent functional recovery in previous randomized-trial meta-analyses. Since those syntheses, the evidence base has expanded to include IAT-TOP, restricted to basilar artery occlusion, and CHOICE-2, in which 90-day mortality was 12.1% with adjunctive alteplase and 6.4% with thrombectomy alone. We therefore examined how the efficacy and mortality profiles changed as randomized evidence accumulated.