Does thrombolysis add value to thrombectomy for acute ischaemic stroke?

The first reperfusion therapy shown to improve the outcomes of patients with acute ischaemic stroke, and become standard medical care, was intravenous thrombolysis with alteplase administered within 4·5 h of symptom onset.1 The second reperfusion therapy to improve outcomes in patients with proximal anterior circulation artery occlusion compared with standard care was endovascular treatment with thrombectomy within 12 h of stroke onset.2 Most participants in the randomised controlled trials (RCTs) of endovascular treatment with thrombectomy versus control (ie, no endovascular thrombectomy) received alteplase as part of background standard care, but 15% of participants did not receive alteplase due to ineligibility.2 Subgroup analyses showed no heterogeneity of the effect of thrombectomy in those who received, and did not receive, alteplase (pinteraction=0·43).2 These analyses resulted in the hypothesis that alteplase might not add value when administered before thrombectomy. [...]adding thrombolysis to thrombectomy could increase the probability of functional independence at 90 days. Latin American nurse comforting a hospitalized sick woman at the hospital - healthcare and medicine Hispanolistic/Getty Images GJH reports personal honoraria outside the submitted work from the American Heart Association (as an Associate Editor for Circulation), AC Immune (as a member of the data safety monitoring committee for the ACI-35–1802 trial of immune therapies for Alzheimer's disease), Bristol Myers Squibb (as a member of the steering committee for the AXIOMATIC-SSP trial of milvexian [factor XIa inhibitor] for secondary stroke prevention), and Janssen (as Co-chair of the executive committee for the Librexia Stroke trial of milvexian for secondary stroke prevention).