Moving Intravenous Thrombolysis for Stroke Beyond 4.5 Hours

Current guidelines recommend that intravenous (IV) alteplase should only be administered for patients with acute stroke who meet criteria and can be treated within 4.5 hours. However, some patients with salvageable brain tissue beyond the current time window might benefit from IV alteplase. These authors investigated whether alteplase could improve outcome in patients presenting within the 4.5- to 9-hour time window (or within 9 hours of the midpoint of sleep with stroke upon waking) who had radiologic evidence of salvageable brain tissue. Of those who underwent advanced brain imaging, 225 had a proven disparity between the infarct core and volume of hypoperfused tissue (radiologic mismatch). The primary study outcome was functional status …