Intra-Arterial Alteplase After Successful Thrombectomy Linked to Better 90-Day Outcomes: JAMA

Researchers have found in a new study that among patients with acute anterior-circulation large-vessel occlusion stroke who achieved successful reperfusion via mechanical thrombectomy, adjunctive intra-arterial alteplase improved the likelihood of excellent functional outcomes at 90 days. This suggests that even after successful mechanical clot removal, targeted thrombolytic therapy may enhance microvascular reperfusion and support recovery of affected brain tissue. The study highlights the potential of combining mechanical and pharmacologic strategies to optimize stroke outcomes, particularly in severe occlusions where residual microthrombi may persist.

Although intra-arterial alteplase showed numerical increases in all-cause mortality and intracranial hemorrhage, these differences were not statistically significant, indicating that the therapy’s benefits on functional recovery are not offset by major safety concerns in this context. The study underscores the importance of individualized patient selection and careful monitoring, emphasizing that combining therapies may offer incremental gains for patients at high risk of poor outcomes. The findings may influence clinical protocols, encouraging consideration of intra-arterial thrombolysis as an adjunct for select patients following successful thrombectomy.

By integrating intra-arterial alteplase into post-thrombectomy care could represent a meaningful step toward improving long-term independence and quality of life for stroke survivors. The researchers recommend further studies to refine dosing, timing, and patient eligibility criteria, while also exploring the underlying mechanisms driving improved functional outcomes. Meanwhile, clinicians should weigh potential benefits against individual patient risk factors and continue monitoring for adverse events. This study adds to a growing body of evidence supporting combination therapies in acute stroke care and highlights the ongoing evolution of strategies aimed at maximizing neurological recovery.

Keywords: Intra-arterial alteplase, mechanical thrombectomy, acute stroke, functional outcomes, anterior-circulation stroke, thrombolysis, reperfusion

Reference : Bhogal, P., Nogueira, R. G., Menon, B. K., et al. (2025). Intra-arterial alteplase after successful thrombectomy linked to better 90-day outcomes. *JAMA, 334*(15), 1552–1563. [https://doi.org/10.1001/jama.2025.2839937](https://doi.org/10.1001/jama.2025.2839937)