When recanalization is not reperfusion: The no-reflow challenge in stroke.

30.2%; adjusted risk ratio 1.45; p = 0.01) compared with standard care, with numerically higher rates of any intracranial hemorrhage and mortality that did not reach statistical significance.[ 13 ] Most recently, the CHOICE 2 trial demonstrated a 15% absolute increase in excellent functional outcomes (57.5% vs. 42.9%; number needed to treat ≈7) with IA alteplase and a reduction in persistent hypoperfusion on imaging, without a significant increase in sICH, although all-cause mortality was numerically higher in the lytic arm.[ 1 ] Collectively, these studies suggest that adjunctive IA lytic therapy following technically successful EVT may augment microvascular reperfusion and improve functional outcomes.

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