Understanding Adjunct Thrombolysis After Thrombectomy in Large Vessel Occlusion Stroke: Angel Chamorro, MD, PhD

WATCH TIME: 2 minutes |Captions are auto-generated and may contain errors.

“We thought that once the large clot was removed, the job was done. This trial proves that the microcirculation is the real therapeutic target.”

Large-vessel occlusion (LVO) 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. Quickly confirming the blockage with vascular imaging is essential, because 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.¹

LVO acute ischemic stroke was a recurring focus at the 2026 International Stroke Conference (ISC), held February 4-6, in New Orleans, Louisiana. Among the late-breaking abstracts, a study led by Angel Chamorro, MD, PhD, professor of neurology at the University of Barcelona, evaluated outcomes following the addition of intra-arterial thrombolysis (IAT) with alteplase after successful endovascular thrombectomy (EVT) in patients with LVO acute ischemic stroke.²

Also known as the CHOICE2 trial (NCT05797792), results showed that combining EVT with adjunct IAT significantly improved functional outcomes. At 90 days, the rate of excellent functional recovery was higher in the EVT+IAT group (57.5%) compared with EVT alone (42.5%). In addition, rates of poor microvascular reperfusion were lower with combination therapy (28.6% vs 50.5%, respectively).² To gain further insight into these adjunctive treatment strategies, NeurologyLive spoke with Chamorro about the clinical implications of these findings.

In the interview, Chamorro 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. He noted that 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.

Click here for more ISC 2026 coverage.

REFERENCES
1. Powers W, Rabinstein A, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211
2. Infusion of clot-buster medication after clot removal may improve stroke recovery. American Stroke Association. News Release. February 4. Accessed February 4, 2026. https://newsroom.heart.org/news/infusion-of-clot-buster-medication-after-clot-removal-may-improve-stroke-recovery?preview=2b3c&preview_mode=True