Adjunctive intra-arterial thrombolysis after thrombectomy: Findings from the RITE registry
Bibliographic record
Abstract
Background Despite the excellent recanalization rates following thrombectomy, significantly fewer patients have favorable outcomes. Impaired reperfusion of the microcirculation caused by distal thrombi could contribute to that, and adjunctive intraarterial thrombolysis such as alteplase (IA-tPA) might improve outcomes. We assessed the impact of adjunctive IA-tPA following thrombectomy with TICI score ≥ 2A on functional outcomes and reperfusion status. Methods A retrospective analysis of patients with LVO ischemic stroke who underwent EVT. Patients were dichotomized into those who received EVT + IA-tPA vs EVT alone. Primary outcomes were favorable functional outcome (90-day mRS 0–2), and 90-day home-time. Results 354 patients were included, of which 133 (37.6%) were treated with EVT + IA-tPA and 221 (62.4%) were treated with EVT alone. Baseline characteristics were similar in both groups. The non-IA-tPA group had a significant proportion of patients with higher baseline TICI scores (P < 0.0001). There was no significant difference in the rate of favorable functional outcomes between patients who received IA-tPA vs those who did not (59.8% vs 66.1%; p = 0.27), 90-day home time was 77 (69–83) vs 66 (60–81) days, p = 0.26. There was no difference in the rate of sICH (2.2% vs 2.3%; P = 0.99), and mortality (15% vs 8.3%; P = 0.06). IA-tPA resulted in a significant improvement in TICI scores from 33.3% to 62.9% and was 3.4 times more likely to improve reperfusion status. Conclusion IA-tPA following thrombectomy with TICI score ≥ 2A appeared to be safe and improved the final TICI score; however, this angiographic improvement did not translate into functional outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".