6/28/23, 12:08 AM CHOICE (alteplase) Pathway Feedback Search Clinical Topics Home Studies CHOICE (alteplase) CHOICE (alteplase) Disease Acute ischemic stroke Trial question What is the effect of intra-arterial alteplase in patients with large vessel occlusion acute ischemic stroke? Study design Multi-center Double blinded RCT Population Characteristics of study participants 46.0% female N = 113 54.0% male 113 patients (52 female, 61 male) Inclusion criteria: patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy Key exclusion criteria: contraindication to the use of intravenous alteplase; NIHSS score on admission > 25; complete clinical recovery in the angiography suite during the procedure Interventions N=61 alteplase (intra-arterial infusion of a dose of 0.225 mg/kg over 15-30 minutes) N=52 placebo (intra-arterial infusion of a matching placebo over 15 minutes) Primary outcome Percentage of patients with modified Rankin Scale score of 0 or 1 at 90 days 59.0 % 59 https://web.pathway.md/studies/recsEsvuL2OQ8OUvO 1/2 6/28/23, 12:08 AM CHOICE (alteplase) Pathway 44.3 % 40.4 29.5 % Significant increase 14.8 % NNH = 5 0.0 % Alteplase Placebo Significant increase in the percentage of patients with mRS score of 0 or 1 at 90 days (59% vs. 40.4%; AD 18.4%, 95% CI 0.3 to 36.4) Secondary outcomes No significant difference in the percentage of patients with improved angiographic eTICI score (8.5% vs. 7.7%; AD 0.6%, 95% CI -9.5 to 10.7) No significant difference in the percentage of patients with infarct expansion (63.9% vs. 74.5%; ARD -8.9, 95% CI -25.6 to 7.9) No significant difference in the percentage of patients with ischemic worsening (1.6% vs. 5.8%; ARD -4.9, 95% CI -18 to 8.3) Safety outcomes No significant differences in symptomatic intracranial hemorrhage, death at day 90. Conclusion In patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, alteplase was superior to placebo with respect to the percentage of patients with mRS score of 0 or 1 at 90 days. Reference Arturo Ren , M nica Mill n, Luis San Rom n et al. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Mar 1;327(9):826-835. Open reference URL https://web.pathway.md/studies/recsEsvuL2OQ8OUvO 2/2