# Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study

## TL;DR

This study examines whether stroke patients with brain malformations can safely receive clot-dissolving treatment, finding it may improve recovery without increasing risks.

## Contribution

The study provides new evidence from a large nationwide cohort on the safety and efficacy of IVT in AIS patients with CCMs.

## Key findings

- IVT was associated with higher functional independence in AIS patients with CCMs.
- No significant increase in mortality or intracranial hemorrhage was observed with IVT.
- Literature review identified only 34 cases, highlighting limited prior data.

## Abstract

Background: Intravenous thrombolysis (IVT) is relatively contraindicated in acute ischemic stroke (AIS) patients with intracranial vascular malformations per current guidelines. Thus, the presence of cerebral cavernous malformations (CCMs) may complicate treatment decision-making. Methods: We performed a literature review of the PubMed, Embase, Scopus, and Web of Science databases through July 2025, identifying reported cases of IVT administration in AIS patients with CCMs. Additionally, we conducted a retrospective cohort study using the Nationwide Readmissions Database (2016–2022) of AIS patients with CCM, and assessed outcomes with IVT versus no IVT treatment. The primary outcome was functional independence at discharge; secondary outcomes included mortality and intracranial hemorrhage (ICH). Results: Only 34 CCM patients across 7 studies were identified in the literature, with symptomatic ICH occurring in 2 cases (5.9%). In the nationwide cohort, 846 AIS patients with CCMs were included, of whom 240 (28.4%) received IVT. Compared to no IVT treatment, IVT was associated with significantly higher rates of functional independence (46.4% vs. 24.6%, adjusted OR [aOR] 3.04 [95% CI 1.98–4.68], p < 0.001), without significant differences in mortality (8.5% vs. 8.3%, aOR 1.40 [95% CI 0.52–3.76], p = 0.50) or ICH (20.3% vs. 16.1%, adjusted OR 1.01 [95% CI 0.53–1.93], p = 0.97). Conclusions: The current literature on the safety and efficacy of IVT in AIS patients with CCMs is limited. Our nationwide study suggests that IVT was associated with higher rates of early functional independence without increased risks of hemorrhage or death among patients with CCM.