Perfusion-Guided IV Thrombolysis for Late Presenting Ischemic Stroke

A meta-analysis of randomized trials found increased favorable outcomes with IV alteplase in patients presenting >4.5 hours after symptom onset who were selected by perfusion imaging, but questions remain.

Intravenous thrombolysis (IVT) with tissue plasminogen activator is recommended for patients with acute ischemic stroke (AIS) within 4.5 hours of onset, but not after. Studies have shown benefit with mechanical thrombectomy up to 24 hours after onset of symptoms for patients identified by perfusion imaging, and this strategy for identifying patients could potentially be applied to extend the window for IVT treatment.

To assess the effect of perfusion-based administration of IVT to patients with AIS and onset presumed to be >4.5 hours, researchers performed a systematic review and meta-analysis of randomized placebo-controlled studies. Three multicenter trials (all stopped early, but otherwise at low risk of bias) and one small pilot study we…

Reviewing Author

Benton R. Hunter, MD

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Chair, Evidence Based Healthcare Interest Group)

Benton R. Hunter, MD

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Chair, Evidence Based Healthcare Interest Group)

Perfusion-Guided IV Thrombolysis for Late Presenting Ischemic Stroke

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Reviewing Author