The CHOICE-2 randomized clinical trial, coordinated by Hospital Clínic Barcelona and IDIBAPS, has been published in JAMA (Journal of American Medical Association). The study demonstrates that administering intra-arterial alteplase immediately after mechanical thrombectomy significantly improves functional outcomes in severe ischemic stroke. The centralized analysis of brain imaging data across the 14-site Spanish trial was conducted by the BCCC Imaging Core Lab.
Key Results
Among the 440 patients enrolled, 57.5% of those receiving the combination treatment achieved excellent functional recovery at 90 days (no disability or minimal symptoms), versus 42.5% in the thrombectomy-only arm. Brain imaging centrally reviewed by BCCC confirmed significantly reduced areas of cerebral hypoperfusion in the combination group, a key indicator of improved microcirculation and a critical driver of neurological recovery.
The CHOICE-2 trial hinged on a precise imaging endpoint: demonstrating that the combination treatment actually improved cerebral microcirculation, not just clinical symptoms. This required measuring areas of hypoperfusion across 14 different hospitals. Without a centralized Core Lab, those measurements would have been subject to inter-site variability and reader bias. BCCC’s Core Lab applied standardized acquisition protocols and blinded, independent image review across all sites, ensuring that the neuroimaging data was consistent and reproducible. In a trial where the imaging findings directly supported the mechanistic explanation for why patients recovered better — reduced hypoperfusion equals better brain perfusion equals better outcomes — the scientific credibility of those images was a key component to the study.
“The rigorous, centralized review of neuroimaging data was essential to objectively demonstrate the impact of the combined treatment on brain perfusion. Our Core Lab protocols ensure that imaging endpoints are evaluated consistently and without bias across all participating sites — and this study is a clear example of how that scientific rigor directly informs clinical conclusions.”
Laura Oleaga, Head of the Imaging Core Lab, BCCC
“Seeing CHOICE-2 published in JAMA is a proud moment for the entire BCCC team. Our Imaging Core Lab’s contribution to this trial reflects our commitment to providing the scientific infrastructure that makes practice-changing research possible. This is exactly the kind of collaboration that defines our mission.”
Xavier Luria, Executive Director, BCCC
Reference: Renú A et al. Adjunctive Intra-Arterial Alteplase After Successful Thrombectomy for Acute Ischemic Stroke: The CHOICE-2 Randomized Clinical Trial. JAMA. May 7, 2026. doi:10.1001/jama.2026.5164
About BCCC
Barcelona Clinical Coordinating Center (BCCC) is a non-profit European CRO specializing in the coordination and management of clinical research projects, providing expertise in trial design, site management, data coordination, as well as regulatory and statistical support. www.bcccbarcelona.com
