Intravenous thrombolysis for acute ischemic stroke with extended time window

Abstract

Background: Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h. Methods: We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0–1) at 90 days, the functional independence (defined as mRS scores 0–2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5–9.0 h or >9.0 h). Results: Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12–1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08–1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35–20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97–3.34). Conclusions: Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.

Prognostic Values Serum Cav-1 and NGB Levels in Early Neurological Deterioration After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

“…25 IAT is established as an effective modality for the treatment of AIS. 26 However, END is reported to occur in 10% of AIS patients after IAT, which is an ominous clinical event tightly related to poor outcomes. 27 Therefore, early identification of END is beneficial for formulating personalized treatment strategies, thus optimizing the management of AIS.…”

Predicting 90-Day Prognosis in Ischemic Stroke Patients Post Thrombolysis Using Machine Learning

“…Another study revealed that patients who received intravenous thrombolysis treatment outside the recommended optimal window of 3-4.5 h from the onset of stroke symptoms, or in cases where the precise onset time was unknown, showed enhanced 90-day post-stroke mRS. However, this particular group also had a higher mortality rate when compared to individuals who did not undergo this treatment [18]. More recently, given that different patients have different physiology, it was noted to be feasible and safe, to have improved neurological function acutely, and to have increased the number of patients with an mRS of 0-1 [19].…”