Tenecteplase, alteplase, and endovascular thrombectomy in extended-window acute ischemic stroke with intracranial large-vessel occlusion: a Bayesian network meta-analysis

Background and purpose: The comparative effects of intravenous thrombolytic agents, endovascular thrombectomy (EVT), and bridging therapy in imaging-selected patients with acute ischemic stroke treated beyond 4.5 hours remain uncertain. We compared these strategies while distinguishing confirmed large-vessel occlusion (LVO) evidence from broader mixed populations.

Methods

We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized trials evaluating reperfusion treatments administered 4.5 to 24 hours after stroke onset or last known well. The primary network included trials requiring confirmed intracranial LVO or basilar artery occlusion (BAO). An anterior-circulation LVO network and an all-available network were examined as sensitivity and exploratory analyses. Bayesian random-effects consistency models estimated odds ratios (ORs) with 95% credible intervals (CrIs). The primary outcome was functional independence, defined as a modified Rankin Scale score of 0 to 2 at 90 days.