In patients with carotid tandem lesions, adding intravenous thrombolysis to endovascular treatment had no significant impact on bleeding or functional outcomes, according to new research. The meta-analysis of data from six randomized controlled trials investigated whether having carotid tandem lesions would affect the safety and efficacy of intravenous thrombolysis in patients who could directly undergo endovascular treatment. Of 2,287 patients with data for carotid tandem lesions in this prespecified secondary analysis, 1,136  were assigned to receive I.V. thrombolysis plus endovascular treatment and 1,131 were assigned to endovascular treatment only. Of the total patients, 340 had carotid tandem lesions and 1,927 did not. Adding I.V. thrombolysis did not increase functional outcome in patients with tandem lesions or in those without tandem lesions, compared with endovascular treatment only. For patients with tandem lesions, rates of intracranial hemorrhage were similar in those receiving the combination treatment and endovascular treatment alone. Symptomatic hemorrhage rates were also similar between the two treatment groups in patients with tandem lesions. “These data suggest that the presence of tandem lesions should not solely influence the decision to administer intravenous thrombolysis to patients who can directly undergo endovascular treatment,” the researchers conclude.