Table 1.
Summary of included studies
| Study | Study type | N | Type of fibrinolytic | Median dose (IQR) | Median dose in patients after IV tPA | Timing | IA fibrinolytics administered after IV tPA | Main indication | MT Technique | sICH definition available | ||
| IA | Non-IA | Rescue after failed or incomplete MT | Primary as conjunction with MT | |||||||||
| Anadani et al 17 | RO of prospective database | 67 | 419 | tPA | 5 mg (2–6 mg) | 5 mg | N/A | Yes (13/67, 19.4%) | Yes | No | ADAPT | No (PH2 used) |
| Heiferman et al 21 | RO | 28 | 12 | tPA | 13.25 mg (8–15.25 mg) | 10 mg | N/A | Yes (15/28) | No | Yes | Stent-retriever thrombectomy | Yes |
| Yi et al 22 | RO | 37 | 56 | tPA | NA, reported as <5 mg | N/A | Not reported | Yes (17/37, 45.9%) | No | Yes | Stent-retriever thrombectomy | Yes |
| Zaidi et al 16 | RO | 37 | 44 | tPA | NA | NA | Not reported | Yes (17/37, 46%) | Yes | No | Stent-retriever thrombectomy | Yes |
| Kaesmacher et al 33 | RO of prospective database | 100 | 893 | uPA | 300000 IU (250000–500000 IU) | 250000 (250000–500000) | Median time to uPA (275 min, IQR 229–313) | Yes (43/100, 43%) | Yes (75%) | Yes (25%) | >90% stent-retriever thrombectomy | Yes |
| Bracard et al 27 | RO of RCT data (THRACE) | 15 | 124 | tPA | 7 mg (3–10 mg) | 7 mg | N/A | Yes (15/15, 100%) | Yes | No | 77.1% stent-retriever thrombectomy 9.3% aspiration 13.6% multiple systems |
Yes |
| Berkhemer et al 26 | RO of RCTA data (MR CLEAN) | 22 | 169 | tPA | NA, reported as 5 mg single dose, up to 30 mg | N/A | N/A | Yes (18/21, 86%, 1 unknown) | Yes | No | Stent-retriever thrombectomy | Yes |
| Goyal et al 25 | RO of RCT data (ESCAPE) | 7 | 158 | tPA | Median dose 5 mg (range 1–7 mg) | N/A | N/A | Yes (5/7, 71.4%) | N/A | N/A | Stent-retriever thrombectomy | Yes |
| Castonguay et al 32 | RO of a prospective database (STRATIS, MCA occlusions only) | 92* | 518* | tPA | Median dose 4 mg (IQR 2–10 mg) | 4 mg | N/A | Yes (66/92, 65.6%) | Yes (20%) | Yes (75%) | Stent-retriever thrombectomy | Yes |
| Total | 9 RO | 405 | 2392 | 8 x tPA, 1 x uPA | Median range tPA 4–13.25 mg | 51.6% (209/405) | >80% stent-retriever | 8/9 Yes | ||||
* numbers slightly differ in comparison to the abstract version, because in this meta-analysis, only patient with available data on sICH are included.
ESCAPE, Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times; IA, intra-arterial; IV, intravenous; MCA, middle cerebral artery; MRCLEAN, Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands; MT, mechanical thrombectomy; N/A, not available; PH2, parenchymal hematoma type 2; RCT, randomized controlled trial; RO, retrospective observational; sICH, symptomatic intracranial hemorrhage; STRATIS, Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke; THRACE, Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke; tPA, tissue plasminogen activator, alteplase; uPA, urokinase.