CHOICE (alteplase)
Trial question
What is the effect of intra-arterial alteplase in patients with large vessel occlusion AIS?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 113
113 patients (52 female, 61 male).
Inclusion criteria: patients with large vessel occlusion AIS and successful reperfusion following thrombectomy.
Key exclusion criteria: contraindication to the use of intravenous alteplase; NIHSS score on admission > 25; complete clinical recovery in the angiography suite during the procedure.
Interventions
N=61 alteplase (intra-arterial infusion of a dose of 0.225 mg/kg over 15-30 minutes).
N=52 placebo (intra-arterial infusion of a matching placebo over 15 minutes).
Primary outcome
Patients with modified Rankin Scale score of < 2 at 90 days
59%
40.4%
59.0 %
44.3 %
29.5 %
14.8 %
0.0 %
Alteplase
Placebo
Significant
increase ▲
NNT = 5
Significant increase in patients with mRS score of < 2 at 90 days (59% vs. 40.4%; AD 18.4%, 95% CI 0.3 to 36.4).
Secondary outcomes
No significant difference in patients with improved angiographic eTICI score (8.5% vs. 7.7%; AD 0.6%, 95% CI -9.5 to 10.7).
No significant difference in patients with infarct expansion (63.9% vs. 74.5%; ARD -8.9, 95% CI -25.6 to 7.9).
No significant difference in patients with ischemic worsening (1.6% vs. 5.8%; ARD -4.9, 95% CI -18 to 8.3).
Safety outcomes
No significant differences in symptomatic ICH, death at day 90.
Conclusion
In patients with large vessel occlusion AIS and successful reperfusion following thrombectomy, alteplase was superior to placebo with respect to patients with mRS score of < 2 at 90 days.
Reference
Arturo Renú, Mónica Millán, Luis 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 Mar 1;327(9):826-835.
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