Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Does Not Help Outcomes
Intra-arterial urokinase administered after near-complete or complete reperfusion by endovascular thrombectomy did not improve clinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion, according to study results published in JAMA.
“Persisting or new thrombi in the distal arteries and the microcirculation have been reported to limit the benefits of successful endovascular thrombectomy for patients with acute ischemic strokes,” explained first author Chang Liu, MD, of The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, China, and coauthors in the study introduction. “It remains uncertain whether intra-arterial thrombolysis by urokinase following near-complete to complete reperfusion by thrombectomy improves outcomes.”
To investigate, researchers conducted the POST-UK randomized clinical trial across 35 hospitals in China between November 15, 2022, and March 29, 2024. The investigation included 534 patients with proximal intracranial large vessel occlusion, presenting within 24 hours of when they were last known to be well, who achieved near-complete or complete reperfusion by endovascular thrombectomy.
Among patients, 267 received intra-arterial urokinase, and 267 who did not receive intra-arterial thrombolysis served as the control group.
“Adjunctive intra-arterial urokinase to endovascular thrombectomy for acute ischemic stroke did not significantly improve the percentage of patients who survived without disability,” researchers reported.
At 90 days, the percentage of patients who survived without disability, defined as a modified Rankin Scale score of 0 or 1, was 45.1% with intra-arterial urokinase compared with 40.2% in the control group. The resulting adjusted risk ratio of 1.13 for survival without disability with intra-arterial urokinase treatment was not significantly different, according to the study.
In safety outcomes, 90-day mortality rates were 18.4% in the intra-arterial urokinase group and 17.3% in the control group. Rates of symptomatic intracranial hemorrhage were 4.1% in both groups, the study found.
The median age of study participants was 69 years, and 41.8% were women.
