Outcomes of Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST-UK Trial.
Song Jiaxing J, Zhao Xuexiao X, Li Gaoming G, Zhou Mingrui M et al.
Whether adjunctive intra-arterial thrombolysis improves outcomes in patients with acute ischemic stroke due to cardioembolism remains unclear. This study aimed to investigate the efficacy and safety of adjunctive intra-arterial urokinase in patients with acute ischemic stroke due to cardioembolism who achieved near-complete to complete reperfusion. This study was a secondary analysis of the POST-UK (Adjunctive Intra-Arterial Urokinase After Near-Complete to Complete Reperfusion for Acute Ischemic Stroke) trial, which was conducted from November 15, 2022, to March 29, 2024. Patients were randomly assigned to the intra-arterial urokinase group or the control group. The primary outcome was disability-free survival at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90-day all-cause death, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. Among 209 patients with cardioembolism (median age 73 [interquartile range, 63-81] years; 45.9% men), 106 were assigned to the control group and 103 to the intra-arterial urokinase group. Compared with the control group, adjunctive intra-arterial urokinase significantly increased the odds of disability-free survival at 90 days (adjusted risk ratio, 1.49 [95% CI, 1.08-2.06]; P=0.01; inverse probability of treatment weighting adjusted risk ratio, 1.47 [95% CI, 1.04-2.09]; P=0.03). No significant differences were found between groups in 90-day mortality rate, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours. In patients with acute ischemic stroke due to cardioembolism who achieved near-complete to complete reperfusion, adjunctive intra-arterial urokinase significantly improved disability-free survival at 90 days without increasing the risk of death or intracranial hemorrhage. URL: ChiCTR.org.cn; Unique identifier: ChiCTR2200065617.