ESOC 2022 | Intra-arterial alteplase versus placebo after mechanical thrombectomy

Ángel Chamorro, MD, Hospital Clinic de Barcelona, Barcelona, Spain, outlines the Phase IIb randomized, placebo-controlled CHOICE trial (NCT03876119), assessing the effect of intra-arterial alteplase versus placebo following thrombectomy in patients with acute ischemic stroke. A large research focus in the stroke field has been the optimization of endovascular therapy, particularly the role of bridging thrombolysis prior to thrombectomy. Controversy remains regarding the benefit of adjunctive intravenous thrombolysis in these patients. In the CHOICE trial, Prof. Chamorro’s team switch this idea around and instead aim to see if adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. In total, 121 patients with large vessel occlusion were randomized to intra-arterial alteplase or placebo. The difference in proportion of patients achieving 0 or 1 on the 90-day modified Rankin Scale (mRS) was assessed as the primary endpoint. In the alteplase arm, 59.0% achieved an mRS score of 0 or 1, compared to 40.4% in the placebo arm. Placebo shortages and slow enrollment led to early termination of the study, so more evidence is needed to validate these findings. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.