Adjunctive Alteplase Fails to Improve Outcomes in Basilar Artery Occlusion

Mechanical thrombectomy (a procedure using a catheter to physically remove a clot from a blood vessel) has established a high standard of care for acute ischemic stroke, offering significant survival and functional benefits for patients with large-vessel occlusions [1, 2, 3, 4]. While its efficacy is well-documented in the anterior circulation, its application in the posterior circulation, specifically for basilar artery occlusion (a blockage of the primary artery supplying the brainstem), has required rigorous investigation to confirm similar advantages [5, 6]. Despite achieving high rates of successful recanalization (the restoration of blood flow through a previously blocked vessel), many patients still experience poor functional outcomes, prompting clinicians to investigate adjunctive therapies like intra-arterial thrombolysis (the targeted delivery of clot-dissolving medication directly into the affected artery) to resolve residual microvascular obstructions [7, 8, 9]. Current guidelines continue to evolve as researchers determine if combining pharmacological and mechanical approaches can improve clinical recovery [10, 11]. The IAT-TOP trial, a randomized clinical trial involving 246 patients, now provides evidence regarding the utility of this adjunctive approach in the high-stakes setting of posterior circulation stroke [9].