Low-Dose Intra-Arterial Prourokinase for Acute Ischaemic Stroke: A Systematic Review and Meta-Analysis

Prouroquinase Intra-Arterial em Baixa Dose para o Acidente Vascular Cerebral Isquêmico Agudo: Uma Revisão Sistemática e Meta-Análise

Resumen

Introduction: Despite advances in acute ischemic stroke (AIS) treatment, reperfusion remains suboptimal. This study evaluates the efficacy and safety of low-dose intra-arterial prourokinase as an adjunct to standard therapy.

Methods: A systematic search of PubMed and Embase was conducted up to January 18, 2025, to identify randomized controlled trials (RCTs) comparing low-dose intra-arterial prourokinase plus standard treatment versus standard treatment in adults with AIS. Primary outcomes included hemorrhages with clinical deterioration, overall hemorrhagic complications, and mortality. Secondary outcomes assessed functional recovery—using the modified Rankin Scale (mRS 0–1), Barthel Index (≥90), and NIHSS response—as well as complete and partial recanalization at 2 hours. Meta-analyses were performed using a random-effects model, with heterogeneity assessed via the I² statistic.

Results: Two RCTs were included. Prourokinase significantly increased the likelihood of complete recanalization (OR 5.523; 95% CI: 1.449–21.052; p = 0.012) and partial recanalization (OR 5.214; 95% CI: 2.382–11.411; p < 0.001), both with low heterogeneity. No significant differences were observed for mortality (RD 0.522; 95% CI: 0.271–1.007; p = 0.053) or hemorrhages with clinical deterioration (OR 1.954; 95% CI: 0.599–6.371; p = 0.267). Functional outcomes favored prourokinase without statistical significance: mRS 0–1 (OR 1.675; p = 0.151), Barthel Index ≥90 (OR 1.450; p = 0.216), and NIHSS response (OR 1.804; p = 0.172).

Conclusions: Low-dose intra-arterial prourokinase enhances early recanalization in AIS and suggests potential functional benefit without increasing adverse outcomes.