IV Thrombolysis 4.5–24 Hours After Acute Ischemic Stroke | EAN Paper of the Month – September 2026
IV Thrombolysis 4.5–24 Hours After Acute Ischemic Stroke | EAN Paper of the Month – September 2026
• Study: Updated systematic review and meta-analysis of 13 studies including 4,867 patients with acute ischemic stroke beyond 4.5 hours or with unknown onset.
• Treatment: 2,456 received IV thrombolysis plus best medical therapy; 2,411 received best medical therapy alone.
• Excellent functional outcome at 90 days (mRS 0–1): improved with thrombolysis (RR 1.23; 95% CI 1.15–1.33; NNT 13).
• Good functional outcome (mRS 0–2): also improved (RR 1.15; 95% CI 1.05–1.25).
• Safety: Symptomatic intracranial hemorrhage increased (RR 2.11; NNH 75), but 90-day mortality was not significantly increased.
• Patient selection is key: CT first excludes intracranial hemorrhage, CTA identifies large-vessel occlusion and potential need for thrombectomy, while CT perfusion or MRI can identify patients with limited established infarction and salvageable brain tissue.
• Clinical message: The 4.5-hour window is not an absolute barrier in appropriately selected patients; advanced imaging can identify those who may still benefit from IV thrombolysis.
Source: European Academy of Neurology (EAN), Research Paper of the Month, September 7, 2026
