Intra-Arterial Alteplase Thrombolysis during Mechanical Thrombectomy for Acute Ischemic Stroke

J Stroke Cerebrovasc Dis. 2017 Dec;26(12):3004-3008. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.031. Epub 2017 Aug 23.


Background: Intra-arterial alteplase (IA tPA) is commonly used during mechanical thrombectomy for acute ischemic stroke in patients with large-vessel occlusion, but specific indications and applications for its use remain undefined.

Methods: We analyzed 40 patients who underwent stent-retriever mechanical thrombectomy, 28 of whom received adjunctive IA tPA. To our knowledge, this is the largest cohort with this concomitant treatment reported in the literature in the post-mechanical thrombectomy trial era.

Results: Between patients with and without IA tPA, rates of hemorrhagic conversion, neurologic outcome, and mortality were equivalent, with a trend toward improved angiographic revascularization observed in the IA tPA group.

Conclusions: IA tPA is a safe adjunct to mechanical thrombectomy, and more investigation is warranted to understand ideal indications and dosage methodologies.

Keywords: Ischemic stroke; alteplase; endovascular therapy; intra-arterial thrombolysis; large-vessel occlusion; mechanical thrombectomy; stentriever; tPA.

MeSH terms

  • Aged
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Cerebral Angiography / methods
  • Computed Tomography Angiography
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Infusions, Intra-Arterial
  • Male
  • Mechanical Thrombolysis / adverse effects
  • Mechanical Thrombolysis / methods*
  • Mechanical Thrombolysis / mortality
  • Middle Aged
  • Risk Factors
  • Stroke / diagnostic imaging
  • Stroke / mortality
  • Stroke / physiopathology
  • Stroke / therapy*
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Thrombolytic Therapy / mortality
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator