Adjunct Thrombolysis After Thrombectomy Improves Recovery in LVO Stroke

Combining mechanical thrombectomy with adjunct intra-arterial alteplase significantly improved functional outcomes in patients with large-vessel occlusion (LVO) acute ischemic stroke, according to results from the CHOICE2 trial presented at ISC 2026. At 90 days, the rate of excellent functional recovery was higher in the endovascular thrombectomy (EVT) plus intra-arterial thrombolysis (IAT) group (57.5%) compared with EVT alone (42.5%). Rates of poor microvascular reperfusion were also lower with combination therapy (28.6% vs 50.5%).

Large-vessel occlusion acute ischemic stroke is a severe form of stroke caused by blockage of a major cerebral artery, leading to abrupt loss of blood flow to large areas of the brain. These strokes are often associated with significant neurologic deficits, including weakness, speech impairment, and altered consciousness, and carry a high risk of long-term disability. Restoring blood flow, most often through mechanical thrombectomy, sometimes combined with clot-dissolving medication, can significantly improve recovery when performed within the recommended treatment window.

A professor of neurology from the University of Barcelona explained that the trial results fundamentally shift understanding of stroke treatment by demonstrating that the microcirculation, not just large vessel clots, is a critical therapeutic target. Historically, treatment focused almost exclusively on removing major arterial clots through mechanical thrombectomy, with the assumption that restoring large-vessel patency completed the job. However, the findings from CHOICE2 suggest that even after successful clot retrieval, microvascular obstruction can persist due to microthrombi formation and oxidative stress within the small vessels. 'We thought that once the large clot was removed, the job was done. This trial proves that the microcirculation is the real therapeutic target,' the investigator stated.

In a separate systematic review and meta-analysis presented at the 2026 American Headache Society annual meeting, researchers assessed headache frequency among patients after a hemorrhagic stroke. The overall pooled headache frequency was 46%. Prevalence was 38% (95% CI: 25–53%) among patients with intracerebral hemorrhage and 48% (95% CI: 37–59%) among those with subarachnoid hemorrhage. The research team included 22 primary research articles in the meta-regression and meta-analysis and 43 in the systematic review; studies were published between inception and 2024. Being female was associated with higher odds of experiencing headaches after hemorrhagic stroke (pooled OR 0.82, 95% CI 0.68–0.99), and patients with a prior medical history of primary headache had greater odds of experiencing post-stroke headaches (pooled OR 4.83, 95% CI 2.10–11.10). The researchers concluded that future research should use standardized diagnostic criteria, clearly define study populations, and report detailed headache characteristics, and noted a lack of clinical trials on post-stroke headache treatments.

Another study, published online June 10 in Neurology Open Access, found that few patients with stroke or traumatic brain injury (TBI) receive inpatient rehabilitation facility (IRF) care after hospitalization. The retrospective cohort study used State Inpatient Databases of Florida, Georgia, Maryland, New York, and Washington for 2016 to 2019 and included 444,908 adults with a principal diagnosis of stroke, TBI, or traumatic spinal cord injury (TSCI). Of these, 21.8%, 26.4%, and 53.5% were discharged to IRF, skilled nursing facilities (SNFs), and home, respectively. IRF discharge was highest in TSCI (43.5%), followed by stroke (21.8%) and TBI (13.7%), and remained stable over time. Higher odds of institutional rehabilitation versus home were seen for older patients, women, and non-Hispanic Blacks (adjusted odds ratios [aORs], 1.04, 1.19, and 1.29, respectively). Lower odds of institutional discharge versus home were seen with private insurance versus Medicare (aOR, 0.65) and with higher ZIP-code income (highest versus lowest quartile: aOR, 0.88). The odds of IRF versus SNF discharge were lower for non-Hispanic Black patients (aOR, 0.90) and higher for private insurance versus Medicare (aOR, 1.73) and higher area income (aOR, 1.33). 'Receiving intensive rehabilitation after stroke, traumatic brain injury, and spinal cord injury can improve a person's recovery, yet access to inpatient rehabilitation care remains inconsistent and may not be equitable,' a study coauthor stated.