Abo‐elnour, Dina Essam

Abstract Background and aims Intravenous thrombolysis (IVT) is the most common acute ischemic stroke (AIS) treatment. This study compared the efficacy and safety of different IVT agents to determine the optimal option for AIS management. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL until 23 March 2025. Randomized controlled trials (RCTs) on alteplase (tPA), tenecteplase (TNK), reteplase, and recombinant human pro-urokinase (rhPro-UK) of any dose in AIS were included. A frequentist network meta-analysis was conducted using R software to pool risk ratios (RRs) with 95% confidence intervals (CIs). Results Twenty-one RCTs (10,852 patients) were included. Compared with tPA 0.9 mg/kg, tPA 0.6 mg/kg showed a lower risk of symptomatic intracranial hemorrhage (RR, 95% CI: 0.48 [0.27–0.86]), whereas TNK 0.4 mg/kg showed a higher risk (RR, 95% CI: 1.88 [1.06–3.35]). Reteplase 18 + 18 mg (RR, 95% CI: 1.13 [1.05–1.21]) and TNK 0.25 mg/kg (RR, 95% CI: 1.05 [1.01–1.10]) were associated with higher rates of excellent functional outcome at 90 days (mRS 0–1) compared with tPA 0.9 mg/kg. No significant differences were observed among interventions in 90-day mortality and favorable function outcomes (mRS 0–2), or serious adverse events. Conclusions Thrombolytic efficacy and safety in AIS appear to be dose dependent. A lower tPA dose (0.6 mg/kg) improved safety; reteplase 18 + 18 mg and TNK 0.25 mg/kg favored functional recovery, whereas a higher TNK dose increased sICH risk, underscoring the importance of dose optimization in IVT selection. Conflict of interest Haneen Sabet: nothing to disclose, Moaz Elsayed Abouelmagd: nothing to disclose, Abdelrahman Shata: nothing to disclose, Mohamed El-Moslemani: nothing to disclose, Diana Kadi: nothing to disclose, Dina Essam Abo-elnour: nothing to disclose, Abdallah Abbas: nothing to disclose, Ramanathan Kadirvel: nothing to disclose, Sherief Ghozy: nothing to disclose Figure 1 - belongs to Results

Background The Woven EndoBridge (WEB) device is an effective treatment for wide‐neck aneurysms (WNA). This study aims to identify and compare anatomical and procedural factors that predicts the aneurysm occlusion, both adequate and inadequate after WEB device treatment. Methods A systematic review and meta‐analysis were conducted using PubMed, Embase, Scopus, and Web of Science, including studies up to October 25, 2024. Data on angiographic outcomes of WEB occlusion were extracted and analyzed using R version 4.4.2 Results Nine studies (790 patients) were included. Female patients were 1.64 times more likely to achieve adequate occlusion than males (OR: 1.64, 95% CI: [1.06, 2.52], p = 0.026). Regular‐shaped aneurysms had a 2.44‐fold higher likelihood of adequate occlusion compared to irregular ones (OR: 0.41, 95% CI: [0.23, 0.74]). Aneurysm neck size was significantly smaller in the adequate occlusion group (3.9 mm vs. 4.4 mm, MD: ‐0.48 mm, 95% CI: [‐0.78, ‐0.18], p = 0.002). Maximum aneurysm diameter was also smaller in the adequate occlusion group (5.7 mm vs. 6.8 mm, MD: ‐1.13 mm, 95% CI: [‐1.69, ‐0.57], p < 0.001). Aneurysm height was also significantly lower than the inadequate occlusion group (5.4 mm vs. 6.3 mm, MD: ‐0.92 mm, 95% CI: [‐1.55, ‐0.29], p = 0.004). Conclusion Smaller aneurysm dimensions, regular shape, and female gender were associated with higher adequate occlusion rates after WEB treatment. These findings may guide patient selection strategies for optimizing aneurysm occlusion. Further high‐quality studies are needed to confirm these associations. image image