机构：[1]Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, China.[2]Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.[3]Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China.[4]Department of Neurology, Qujing No. 1 Hospital Affiliated Hospital of Kunming Medical University, Qujing, China.[5]Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.[6]Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China.[7]Department of Neurosurgery, The People's Hospital of Qiandongnan Autonomous Prefecture, Kaili, Guizhou, China.[8]Department of Neurology, Chongzhou Hospital, Chongzhou, Sichuan, China.[9]Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China.[10]Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Hainan, China.[11]Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Yuancheng District, Heyuan, Guangdong, China.广东省人民医院[12]Department of Neurosurgery, Changsha Hospital of Traditional Chinese Medicine (Eighth Hospital of Changsha), Changsha, China.[13]Department of Neurology, Zigong First People's Hospital, Zigong, Sichuan, China.[14]Department of Neurology, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, China.[15]Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.[16]Department of Neurology, Wuhan Puren Hospital, Wuhan, Hubei, China.[17]Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, Guangxi, China.[18]Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China.[19]Department of Neurology, Jingdezhen No. 1 People's Hospital, Jingdezhen, Jiangxi, China.[20]Department of Neurology, Hospital 302 Attached to Anshun Group, Anshun, Guizhou, China.[21]Department of Neurology, Xiangzhou District People's Hospital, Xiangyang, Hubei, China.[22]Department of Neurology, ChongGang General Hospital, Chongqing, China.[23]The Department of Neurology, Xi'an XD Group Hospital, Xi'an, Shanxi, China.[24]Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.[25]Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, China.[26]Department of Neurology, Guiping People's Hospital, Guiping, Guangxi, China.[27]Department of Neurology, Suining Central Hospital, Suining, China.[28]Department of Neurology, Yunyang County People's Hospital, Yunyang, Chongqing, China.[29]Department of Neurology, Dali Bai Autonomous Prefecture People's Hospital, Yunnan, China.[30]Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.[31]Department of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.[32]Diagnostic and Interventional Neuroradiology, CIC-IT 1415, CHRU de Tours, Tours, France.[33]Le Studium Loire Valley Institute for Advanced Studies, Orleans, France.[34]Departments of Neurology and Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.[35]Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.[36]Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California.[37]Associate Editor, JAMA.
Persisting or new thrombi in the distal arteries and the microcirculation have been reported to limit the benefits of successful endovascular thrombectomy for patients with acute ischemic stroke. It remains uncertain whether intra-arterial thrombolysis by urokinase following near-complete to complete reperfusion by thrombectomy improves outcomes among patients with ischemic stroke due to large vessel occlusion.To assess the efficacy and adverse events of intra-arterial urokinase after near-complete to complete reperfusion by thrombectomy for acute ischemic stroke due to large vessel occlusion.This investigator-initiated, randomized, open-label, blinded-end point trial was implemented at 35 hospitals in China, enrolling 535 patients with proximal intracranial large vessel occlusion presenting within 24 hours of time last known well, who achieved near-complete or complete reperfusion by endovascular thrombectomy and did not receive intravenous thrombolysis prior to the procedure. Recruitment took place between November 15, 2022, and March 29, 2024, with final follow-up on July 4, 2024.Eligible patients were randomly assigned to the intra-arterial urokinase group (a single dose of intra-arterial 100 000 IU urokinase injected in the initial target territory; n = 267) or control group (without intra-arterial thrombolysis; n = 267).The primary efficacy outcome was the percentage of patients achieving survival without disability (modified Rankin Scale score of 0 or 1) at 90 days. The primary safety outcomes were mortality at 90 days and incidence of symptomatic intracranial hemorrhage within 48 hours.A total of 535 patients were enrolled (median age, 69 years; 223 [41.8%] female) and 532 (99.6%) completed the trial. The percentage of patients with survival without disability at 90 days was 45.1% (120/266) in the intra-arterial urokinase group and 40.2% (107/266) in the control group (adjusted risk ratio, 1.13 [95% CI, 0.94-1.36]; P = .19). Mortality at 90 days (18.4% vs 17.3%, respectively; adjusted hazard ratio, 1.06 [95% CI, 0.71-1.59]; P = .77) and incidence of symptomatic intracranial hemorrhage (4.1% vs 4.1%, respectively; adjusted risk ratio, 1.05 [95% CI, 0.45-2.44]; P = .91) were not significantly different between groups.Among patients with acute ischemic stroke due to large vessel occlusion, adjunct intra-arterial urokinase after near-complete to complete reperfusion by endovascular thrombectomy did not significantly increase the likelihood of survival without disability at 90 days.ChiCTR.org.cn Identifier: ChiCTR2200065617.
基金：
This study was supported by the
National Natural Science Foundation of China
(82425021, 82001264, 82271349), Natural Science
Foundation of Chongqing
(CSTB2024NSCQ-MSX0359), Chongqing
Technology Innovation and Application
Development Project (CSTB2022TIAD-KPX0160),
the National Natural Science Foundation of China
Major Program (82090040), and China
Postdoctoral Science Foundation (2023M740444).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2025]版：
无
最新[2023]版：
大类|1 区医学
小类|1 区医学：内科
第一作者：
第一作者机构：[1]Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, China.[2]Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
共同第一作者：
通讯作者：
推荐引用方式(GB/T 7714)：
Liu Chang,Guo Changwei,Li Fengli,et al.Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke: The POST-UK Randomized Clinical Trial[J].JAMA.2025,doi:10.1001/jama.2024.23480.
APA：
Liu Chang,Guo Changwei,Li Fengli,Yu Nizhen,Huang Jiacheng...&Yang Qingwu.(2025).Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke: The POST-UK Randomized Clinical Trial.JAMA,,
MLA：
Liu Chang,et al."Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke: The POST-UK Randomized Clinical Trial".JAMA .(2025)
医学