Intraarterial Thrombolysis as an Adjunct to Thrombectomy in Acute Ischemic Stroke: Current Status and Future Prospects
Adnan I. Qureshi
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Department of Neurology, University of Missouri, Columbia, Missouri, USA
Search for more papers by this authorMohammed M. Al-Salihi
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Search for more papers by this authorCorresponding Author
Ibrahim A. Bhatti
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Department of Neurology, University of Missouri, Columbia, Missouri, USA
Correspondence: Ibrahim A. Bhatti ([email protected])
Search for more papers by this authorMaryam S. Al-Jebur
College of Medicine, University of Baghdad, Baghdad, Iraq
Search for more papers by this authorAhmed Abd Elazim
Department of Neurology, University of South Dakota, Sioux Falls, South Dakota, USA
Search for more papers by this authorSameer A. Ansari
Department of Radiology, Northwestern Medicine, Chicago, Illinois, USA
Search for more papers by this authorDaniel E. Ford
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorDaniel F. Hanley
Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorAmeer E. Hassan
Department of Neurology, Valley Baptist-University of Texas Rio Grande Valley, Harlingen, Texas, USA
Search for more papers by this authorPashmeen Lakhani
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Search for more papers by this authorDavid R. Mehr
Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
Search for more papers by this authorThanh N. Nguyen
Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
Search for more papers by this authorAlejandro M. Spiotta
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
Search for more papers by this authorWilliam J. Powers
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
Search for more papers by this authorSyed F. Zaidi
Department of Neurology, University of Toledo, Toledo, Ohio, USA
Search for more papers by this authorAdnan I. Qureshi
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Department of Neurology, University of Missouri, Columbia, Missouri, USA
Search for more papers by this authorMohammed M. Al-Salihi
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Search for more papers by this authorCorresponding Author
Ibrahim A. Bhatti
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Department of Neurology, University of Missouri, Columbia, Missouri, USA
Correspondence: Ibrahim A. Bhatti ([email protected])
Search for more papers by this authorMaryam S. Al-Jebur
College of Medicine, University of Baghdad, Baghdad, Iraq
Search for more papers by this authorAhmed Abd Elazim
Department of Neurology, University of South Dakota, Sioux Falls, South Dakota, USA
Search for more papers by this authorSameer A. Ansari
Department of Radiology, Northwestern Medicine, Chicago, Illinois, USA
Search for more papers by this authorDaniel E. Ford
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorDaniel F. Hanley
Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorAmeer E. Hassan
Department of Neurology, Valley Baptist-University of Texas Rio Grande Valley, Harlingen, Texas, USA
Search for more papers by this authorPashmeen Lakhani
Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA
Search for more papers by this authorDavid R. Mehr
Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
Search for more papers by this authorThanh N. Nguyen
Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
Search for more papers by this authorAlejandro M. Spiotta
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
Search for more papers by this authorWilliam J. Powers
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
Search for more papers by this authorSyed F. Zaidi
Department of Neurology, University of Toledo, Toledo, Ohio, USA
Search for more papers by this authorFunding: The authors received no specific funding for this work.
ABSTRACT
Background and Purpose
Intraarterial thrombolysis (IAT) has been sporadically used as an adjunct to mechanical thrombectomy (MT) in acute ischemic stroke patients for nearly two decades to improve distal arterial and microvascular perfusion even in patients with near complete or complete recanalization.
Methods
We provide an overall narrative review that includes a systematic review and meta-analysis of two randomized controlled trials (RCTs), Chemical Optimization of Cerebral Embolectomy and Endovascular Recanalization in Patients with Acute Posterior Circulation Arterial Occlusion, to identify current and future implications. Risk ratios (RRs) were calculated from RCTs using a fixed-effects model. We identified 10 ongoing or planned RCTs after a search on clinicaltrials.gov and other sources, of which eight are in China, one in Europe, and one in Australia.
Results
A previous meta-analysis of 16 (predominantly observational) studies involving 7572 MT-treated patients had identified 14% higher odds of functional independence (modified Rankin scale [mRS] 0–2) at 90 days in patients treated with IAT. In the current analysis of 321 patients who underwent MT in RCTs, 165 were randomized to IAT and 156 were in the control group. The RR of achieving an mRS score of 0–1 at 90 days postrandomization was higher in patients treated with IAT compared with the control group (absolute increase of 12.87%, RR = 1.39, 95% confidence interval [CI] 1.04–1.86). The rate of symptomatic intracerebral hemorrhage (sICH) within 24 h was slightly higher (absolute increase of 1.64%, RR = 0.95, 95% CI 0.07–13.30) in patients treated with IAT. The ongoing RCTs have sample sizes ranging from 80 to 498 that can identify very large minimal clinically important differences (MCIDs) (13%–20% increase) in primary outcomes, but smaller MCIDs (<10%) that can still result in practice changes with interventions associated with low cost and complexity and are easy to implement, such as IAT, will not be identified.
Conclusions
Observational studies and recent RCTs suggest a potential benefit of IAT in improving functional outcomes among patients post-MT, although the potentially increased risk of sICH, inadequate sample sizes, and lack of data from the United States need to be considered. A large, definitive, and generalizable RCT is required to establish the therapeutic value and safety profile of IAT prior to widespread incorporation into routine practice.
Conflicts of Interest
Dr. Qureshi is confounder of Qureshi Medical LLC, QureVasc LLC, and DyQure LLC. Dr. Qureshi also holds a patent on intraarterial sustained release device in the middle meningeal artery. Thanh N. Nguyen is the Associate Editor of Stroke journal and serves on the advisory board for Brainomix and Aruna Bio. The other authors declare no conflicts of interest.
References
- 1A. Ogawa, E. Mori, K. Minematsu, et al., “Randomized Trial of Intraarterial Infusion of Urokinase Within 6 Hours of Middle Cerebral Artery Stroke,” Stroke; A Journal of Cerebral Circulation 38 (2007): 2633–2639.
- 2H. P. Adams, G. del Zoppo, M. J. Alberts, et al., “Guidelines for the Early Management of Adults With Ischemic Stroke,” Stroke; A Journal of Cerebral Circulation 38 (2007): 1655–1711.
- 3E. C. Jauch, J. L. Saver, H. P. Adams, et al., “Guidelines for the Early Management of Patients With Acute Ischemic Stroke,” Stroke; A Journal of Cerebral Circulation 44 (2013): 870–947.
- 4W. J. Powers, A. A. Rabinstein, T. Ackerson, et al., “Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association,” Stroke; A Journal of Cerebral Circulation 50 (2019): e344–e418.
- 5K. Suzuki, Y. Matsumaru, M. Takeuchi, et al., “Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial,” JAMA 325 (2021): 244–253.
- 6R. Lin, N. Vora, S. Zaidi, et al., “Mechanical Approaches Combined With Intra-Arterial Pharmacological Therapy Are Associated With Higher Recanalization Rates Than Either Intervention Alone in Revascularization of Acute Carotid Terminus Occlusion,” Stroke; A Journal of Cerebral Circulation 40 (2009): 2092–2097.
- 7J. Kaesmacher, S. Bellwald, T. Dobrocky, et al., “Safety and Efficacy of Intra-Arterial Urokinase After Failed, Unsuccessful, or Incomplete Mechanical Thrombectomy in Anterior Circulation Large-Vessel Occlusion Stroke,” JAMA Neurology 77 (2020): 318–326.
- 8J. Kaesmacher, T. R. Meinel, C. Kurmann, et al., “Safety and Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: A Systematic Review and Meta-Analysis of Observational Data,” Journal of NeuroInterventional Surgery 2021; 13: 1073–1080.
- 9C. Tao, R. Li, J. Sun, et al., “ Intra-Arterial Tenecteplase After EVT in Acute Posterior Circulation Arterial Occlusion-A Multicenter Randomized Controlled Trial,” paper presented at the European Stroke Organisation Conference (ESOC), Basel, Switzerland, May 17, 2024.
- 10W. Hu, C. Tao, L. Wang, et al., “Intra-Arterial Tenecteplase After Successful Endovascular Recanalisation in Patients With Acute Posterior Circulation Arterial Occlusion (ATTENTION-IA): Multicentre Randomised Controlled Trial,” BMJ 2025; 388:e080489.
- 11A. Renú, M. Millán, L. San Román, et al., “Effect of Intra-Arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial,” JAMA 2022; 327: 826–835.
- 12W. S Smith, “Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Trial, Part I,” AJNR American Journal of Neuroradiology 2006; 27: 1177–1182.
- 13A Abou-Chebl, “Intra-Arterial Therapy for Acute Ischemic Stroke,” Neurotherapeutics 2011; 8: 400–413.
- 14O. A. Berkhemer, P. S. S. Fransen, D. Beumer, et al., “A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke,” New England Journal of Medicine 2015; 372: 11–20.
- 15S. L. Collette, R. P. H. Bokkers, A. Mazuri, et al., “Intra-Arterial Thrombolytics During Endovascular Thrombectomy for Acute Ischaemic Stroke in the MR CLEAN Registry,” Stroke and Vascular Neurology 2023; 8: 17–25.
- 16S. F. Zaidi, A. C. Castonguay, M. A. Jumaa, et al., “Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions,” Stroke; A Journal of Cerebral Circulation 2019; 50: 1003–1006.
- 17M. Shafie and W. Yu, “Recanalization Therapy for Acute Ischemic Stroke With Large Vessel Occlusion: Where We Are and What Comes Next?,” Translational Stroke Research 2021; 12: 369–381.
- 18C. S. Kwok, S. A. Gillani, N. K. Bains, et al., “Mechanical Thrombectomy in Patients With Acute Ischemic Stroke in the USA Before and After Time Window Expansion,” Journal of NeuroInterventional Surgery 2024; 16: 447–452.
- 19T. N. Nguyen, M. Abdalkader, U. Fischer, et al., “Endovascular Management of Acute Stroke,” Lancet 2024; 404: 1265–1278.
- 20F. Seker, M. M. Qureshi, M. A. Möhlenbruch, et al., “Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion,” Stroke; A Journal of Cerebral Circulation 2022; 53: 3594–3604.
- 21M. Rubiera, A. Garcia-Tornel, M. Olivé-Gadea, et al., “Computed Tomography Perfusion After Thrombectomy,” Stroke; A Journal of Cerebral Circulation 2020; 51: 1736–1742.
- 22F. C. Ng, L. Churilov, N. Yassi, et al., “Prevalence and Significance of Impaired Microvascular Tissue Reperfusion Despite Macrovascular Angiographic Reperfusion (No-Reflow),” Neurology 2022; 98: e790–e801.
- 23F. Schmid, G. Conti, P. Jenny, and B Weber, “The Severity of Microstrokes Depends on Local Vascular Topology and Baseline Perfusion,” eLife 10 (2021): e60208.
- 24N. Janjua, A. Alkawi, M. F. K. Suri, and A. I Qureshi, “Impact of Arterial Reocclusion and Distal Fragmentation During Thrombolysis Among Patients With Acute Ischemic Stroke,” American Journal of Neuroradiology 2008; 29: 253.
- 25G. J. Wong, B. Yoo, R. Jahan, et al., “Abstract 56: Frequency, Determinants, and Outcomes of Distal Emboli Related to Mechanical Thrombectomy for Acute Ischemic Stroke,” Stroke; A Journal of Cerebral Circulation 49: A56–A59.
- 26D. C. Morris, K. Davies, Z. Zhang, and M Chopp, “Measurement of Cerebral Microvessel Diameters After Embolic Stroke in Rat Using Quantitative Laser Scanning Confocal Microscopy,” Brain Research 2000; 876: 31–36.
- 27M. Yemisci, Y. Gursoy-Ozdemir, A. Vural, A. Can, K. Topalkara, and T Dalkara, “Pericyte Contraction Induced by Oxidative-Nitrative Stress Impairs Capillary Reflow Despite Successful Opening of an Occluded Cerebral Artery,” Nature Medicine 2009; 15: 1031–1037.
- 28J. P. Desilles, S. Loyau, V. Syvannarath, et al., “Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke,” Stroke; A Journal of Cerebral Circulation 2015; 46: 3241–3248.
- 29N. E. LeCouffe, M. Kappelhof, K. M. Treurniet, et al., “2B, 2C, or 3,” Stroke; A Journal of Cerebral Circulation 2020; 51: 1790–1796.
- 30R. T. Higashida and A. J Furlan, “Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke,” Stroke; A Journal of Cerebral Circulation 2003; 34: e109–e137.
- 31N. E. Furlan, G. J. Luvizutto, P. T. Hamamoto Filho, et al., “Clinical and Functional Outcomes of Patients Receiving Cerebral Reperfusion Therapy: A Stroke Databank Study in Brazil,” Frontiers in Surgery 2022; 9:799485.
- 32L. Winkelmeier, T. D. Faizy, C. Brekenfeld, et al., “Comparison of Thrombolysis in Cerebral Infarction (TICI) 2b and TICI 3 Reperfusion in Endovascular Therapy for Large Ischemic Anterior Circulation Strokes,” Journal of NeuroInterventional Surgery 2024; 16: 1076.
- 33C. Dargazanli, A. Consoli, M. Barral, et al., “Impact of Modified TICI 3 Versus Modified TICI 2b Reperfusion Score to Predict Good Outcome Following Endovascular Therapy,” AJNR American Journal of Neuroradiology 2017; 38: 90–96.
- 34Á. Chamorro, J. Blasco, A. López, et al., “Complete Reperfusion is Required for Maximal Benefits of Mechanical Thrombectomy in Stroke Patients,” Scientific Reports 2017; 7:11636.
- 35V. H. E. Chen, G. K. H. Lee, C. H. Tan, et al., “Intra-Arterial Adjunctive Medications for Acute Ischemic Stroke During Mechanical Thrombectomy: A Meta-Analysis,” Stroke; A Journal of Cerebral Circulation 2021; 52: 1192–1202.
- 36A. I. Qureshi, A. Lodhi, I. N. Akhtar, et al., “Mechanical Thrombectomy With Intra-Arterial Thrombolysis Versus Mechanical Thrombectomy Alone in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis,” International Journal of Stroke 2024; 19: 16–28.
- 37C. S. Kwok, N. K. Bains, D. E. Ford, et al., “Intra-Arterial Thrombolysis as Adjunct to Mechanical Thrombectomy in Acute Ischemic Stroke Patients in the United States: A Case Control Analysis,” Journal of Stroke and Cerebrovascular Diseases 2023; 32:107093.
- 38A. I. Qureshi, Y. Huang, I. A. Bhatti, et al., “Intracerebral Hemorrhage Risk After Adjunct Intraarterial Thrombolysis in Thrombectomy-Treated Acute Ischemic Stroke,” Journal of Neuroimaging 2024; 34: 773–780.
- 39S. F. Zaidi, A. C. Castonguay, O. O. Zaidat, et al., “Intra-Arterial Thrombolysis After Unsuccessful Mechanical Thrombectomy in the STRATIS Registry,” AJNR American Journal of Neuroradiology 2021; 42: 708–712.
- 40A. C. Castonguay, M. A. Jumaa, O. O. Zaidat, et al., “Insights Into Intra-Arterial Thrombolysis in the Modern Era of Mechanical Thrombectomy,” Frontiers in Neurology 2019; 10: 1195.
- 41L. Kellert, F. A. Wollenweber, G. Thomalla, et al., “Thrombolysis Management in Thrombectomy Patients: Real-Life Data From German Stroke Centres,” European Stroke Journal 2017; 2: 356–360.
- 42M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 2021; 372: n71-n.
- 43J. A. C. Sterne, J. Savović, M. J. Page, et al., “RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials,” BMJ 2019; 366:l4898.
- 44J. P. Higgins, S. G. Thompson, J. J. Deeks, and D. G Altman, “Measuring Inconsistency in Meta-Analyses,” BMJ 2003; 327: 557–560.
- 45A. Renú, J. Blasco, M. Millán, et al., “The Chemical Optimization of Cerebral Embolectomy Trial: Study Protocol,” International Journal of Stroke 2021; 16: 110–116.
- 46W. Hu, C. Tao, L. Wang, et al., “Intra-Arterial Tenecteplase Following Successful Endovascular Recanalization in Patients With Acute Posterior Circulation Arterial Occlusion—A Multicenter Randomized Controlled Trial (ATTENTION-IA),” Journal of NeuroInterventional Surgery 2025; 388:e080489 in press.
- 47C. Tao, R. Li, J. Sun, et al., “Intra-Arterial Tenecteplase Following Endovascular Therapy in Patients With Acute Posterior Circulation Arterial Occlusion: Study Protocol and Rationale,” Journal of NeuroInterventional Surgery 2023; 17(e1): e68–e73.
- 48 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, “Tissue Plasminogen Activator for Acute Ischemic Stroke,” New England Journal of Medicine 1995; 333: 1581–1587.
- 49J. P. Broderick, O. Adeoye, and J Elm, “Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials,” Stroke; A Journal of Cerebral Circulation 2017; 48: 2007–2012.
- 50S. Rangaraju, D. Haussen, R. G. Nogueira, F. Nahab, and M Frankel, “Comparison of 3-Month Stroke Disability and Quality of Life Across Modified Rankin Scale Categories,” Interventional Neurology 2017; 6: 36–41.
- 51J. S. Cranston, B. D. Kaplan, and J. L Saver, “Minimal Clinically Important Difference for Safe and Simple Novel Acute Ischemic Stroke Therapies,” Stroke; A Journal of Cerebral Circulation 2017; 48: 2946–2951.
- 52M. Goyal, R. McDonough, M. Fisher, and J Ospel, “The Challenge of Designing Stroke Trials That Change Practice: MCID vs. Sample Size and Pragmatism,” Journal of Stroke 2022; 24: 49–56.
- 53J. Huang, J. Yang, C. Liu, et al., “Intra-Arterial Tenecteplase Following Endovascular Reperfusion for Large Vessel Occlusion Acute Ischemic Stroke: The POST-TNK Randomized Clinical Trial,” JAMA 2025; 333(7): 579–588.
- 54C. Liu, C. Guo, F. Li, et al., “Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke: The POST-UK Randomized Clinical Trial,” JAMA 2025; 333(7): 589–598.
- 55X. Yang, X. He, D. Pan, et al., “Intra-Arterial Alteplase for Acute Ischaemic Stroke After Mechanical Thrombectomy (PEARL): Rationale and Design of a Multicentre, Prospective, Open-Label, Blinded-Endpoint, Randomised Controlled Trial,” BMJ Open 2024; 14:e091059.
- 56X. Hou, J. Huang, C. Guo, et al., “ Safety and Efficacy of Adjunctive Intra-Arterial Tenecteplase Following Successful Thrombectomy in Patients With Large Vessel Occlusion: A Phase 1/2 Randomized Clinical Trial,” preprint, medRxiv, November 18, 2024, https://doi.org/10.1101/2024.11.17.24317449.
10.1101/2024.11.17.24317449 Google Scholar
- 57T Neale, “ Two Trials Boost Intra-Arterial Lytics After Stroke Thrombectomy,” TCTMD, February 11, 2025.
- 58H. Xiaochuan, L. Gang, S. Dapeng, et al., “Intra-Arterial Tenecteplase After Successful Endovascular Therapy (ANGEL-TNK): Protocol of a Multicentre, Open-Label, Blinded End-Point, Prospective, Randomised Trial,” Stroke and Vascular Neurology ahead of print, November 21, 2024, https://doi.org/10.2105/AJPH.2024.307603.
10.2105/AJPH.2024.307603 Google Scholar
- 59D. Zarin, S. Goodman, and J Kimmelman, “Harms From Uninformative Clinical Trials,” JAMA 2019; 322: 813–814..
- 60J. Kaesmacher, N. Abdullayev, B. Maamari, et al., “Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results From the INFINITY Registry,” Journal of Stroke 2021; 23: 91–102.
- 61 Food and Drug Administration (FDA), Oncologic Drugs Advisory Committee (FDA, 2024).
- 62J. Xin Yu, J. P. Hodge, C. Oliva, S. T. Neftelinov, V. M. Hubbard-Lucey, and J Tang, “Trends in Clinical Development for PD-1/PD-L1 Inhibitors,” Nature Reviews Drug Discovery 2020; 19: 163–164.
- 63C. B. Terwee, L. D. Roorda, J. Dekker, et al., “Mind the MIC: Large Variation Among Populations and Methods,” Journal of Clinical Epidemiology 2010; 63: 524–534.
- 64T. Greco, A. Zangrillo, G. Biondi-Zoccai, and G Landoni, “Meta-Analysis: Pitfalls and Hints,” Heart, Lung and Vessel 2013; 5: 219–225.
- 65A. Chaimani, G. Salanti, S. Leucht, J. R. Geddes, and A Cipriani, “Common Pitfalls and Mistakes in the Set-Up, Analysis and Interpretation of Results in Network Meta-Analysis: What Clinicians Should Look for in a Published Article,” Evidence-Based Mental Health 2017; 20: 88–94.
- 66E. Berge, W. Whiteley, H. Audebert, et al., “European Stroke Organisation (ESO) Guidelines on Intravenous Thrombolysis for Acute Ischaemic Stroke,” European Stroke Journal 2021; 6: 1–62.
- 67G. Turc, P. Bhogal, U. Fischer, et al., “European Stroke Organisation (ESO)—European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke,” Journal of NeuroInterventional Surgery 2023; 15:e8.
- 68D. Sacks, B. Baxter, B. C. V. Campbell, et al., “Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke,” International Journal of Stroke 2018; 13: 612–632.
- 69N. Ahmed, H. Audebert, G. Turc, et al., “Consensus Statements and Recommendations From the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018,” European Stroke Journal 2019; 4: 307–317.
Citing Literature
