Thrombolysis for Acute Ischemic Stroke in the Extended Time Window?

New AHA/ASA guidelines based on recent trials give moderate support for treatment of selected late-presenting patients.

The NINDS IV-TPA trial (N Engl J Med 1995; 333:1581) was the first to show that intravenous thrombolysis was beneficial in certain patients with ischemic stroke. One important trial limitation was that patients had to present within 3 hours after symptom onset. Patients with later presentation — primarily those with stroke symptoms upon waking (“wake-up stroke”) — were excluded, because it is not clear when during sleep the symptoms started. Treatment of these patients is now being reevaluated due to recent clinical trial results.

Determination of patient eligibility for thrombolysis has historically been predicated on lack of hemorrhage and presence of extensive early ischemic changes on head computed tomography (CT). Advanced imaging has b…

Authors

Ashutosh P. Jadhav, MD, PhD

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Thrombolysis for Acute Ischemic Stroke in the Extended Time Window?

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Authors