Clot-Buster Infusion Post-Clot Removal Boosts Recovery

Delivering clot-busting medication alteplase to the area after a blood clot is removed from a large artery in the brain may improve stroke recovery, according to a trial conducted at stroke centers in Spain.

Feb. 4, 2026 at 11:39pm

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Research Highlights: Even after a blood clot is removed from a large artery in the brain via a minimally invasive procedure to treat a clot-caused stroke, delivering the clot-busting medication alteplase to the area may improve stroke recovery, according to a trial conducted at stroke centers in Spain. The two-pronged treatment approach may increase the number of people who fully recover from stroke due to a blockage in a large brain artery.

Why it matters

Large-artery ischemic (clot-caused) strokes can cause death and long-term disability because they block large arteries that supply blood to significant areas of the brain. While removing clots directly from blocked brain arteries, a procedure called thrombectomy, is a powerful treatment, more than half of stroke survivors who have their large artery successfully cleared do not achieve full recovery 90 days later. This study suggests that adding alteplase infusion after thrombectomy may further improve outcomes.

The details

In the CHOICE2 trial, more than 400 adults with large-artery ischemic stroke were treated at stroke centers in Spain within 4.5 to 24 hours of their first stroke symptoms. Patients were randomized to receive either clot removal (219 people) or clot removal plus infusion of alteplase into the artery (214 people). At 90 days, participants who received clot-busting medication in addition to clot removal were significantly more likely to achieve excellent functional outcome, less likely to have inadequate blood flow in small vessels of the brain, and rated themselves higher in mobility, self-care, performing usual activities, lower pain/discomfort and depression/anxiety.

  • The study was conducted between December 2023 and August 2025.
  • Preliminary results from an earlier study, CHOICE, were published in 2022.

The players

Ángel Chamorro

Professor of neurology at the University of Barcelona and head of the Comprehensive Stroke Center Hospital Clinic in Barcelona, and the study author.

American Stroke Association

A division of the American Heart Association that organized the International Stroke Conference 2026 where the study findings were presented.

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What they’re saying

“Mechanical thrombectomy alone is often not enough to fully restore blood flow to the injured brain, even when the blocked artery appears successfully reopened. Standard imaging can miss persistent blockages in the brain's smallest blood vessels. Intra-arterial alteplase given after successful thrombectomy significantly increased the chances of an excellent recovery.”

— Ángel Chamorro, Professor of neurology (Mirage News)

“These results are practice-informing but not yet practice-changing on their own. While CHOICE2 strengthens the evidence that intra-arterial alteplase given after successful thrombectomy can improve recovery, broader adoption will require confirmation in additional studies, guideline review and careful consideration of patient selection.”

— Ángel Chamorro, Professor of neurology (Mirage News)

What’s next

Future research will focus on ways to treat the underlying causes leading to the disruption of blood flow in the microcirculation.

The takeaway

This study suggests that adding alteplase infusion after thrombectomy may further improve outcomes for stroke patients by helping to fully restore blood flow to the injured brain, even when the blocked artery appears successfully reopened. However, broader adoption of this approach will require confirmation in additional studies and guideline review.