Comparison of functional and safety outcomes between the extended versus early time window after intravenous thrombolysis and endovascular thrombectomy

Laura Mannismäki, Nicolas Martinez-Majander, Olli Suomalainen, Gerli Sibolt, Maria Girfanova, Miranda Nybondas, Hanna Nissinen, Sami Curtze

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Introduction: Based on recent trials regarding the early time window, omitting intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in eligible patients seems unjustified. Whether this also concerns the extended time window, 4.5 to 9 h from last seen well, is yet unclear. Patients and methods: All consecutive patients treated with IVT, EVT, or IVT plus EVT in the extended time window at Helsinki University Hospital (HUS) between 1/2021 and 12/2022 were compared with matched controls treated in the early time window between 1/2016 and 12/2020. Regression analysis was applied on functional outcome at 90 days, evaluated on modified Rankin Scale (mRS), and on the occurrence of symptomatic intracerebral hemorrhage (sICH), adjusted for potential confounders. Results: Altogether 134 patients and 134 matching controls were included. Functional outcomes did not significantly differ between the extended versus early time window. Among patients with IVT plus EVT, the adjusted odds ratio (aOR) for a favorable outcome shift on mRS was 1.15, 95% confidence interval (CI) 0.54–2.43. Although sICH occurred more frequently (2.2% versus 3.0%) in the extended time window, regression analysis did not show a significant difference, aOR 0.96, 95% CI 0.14–6.87. Discussion and conclusion: We found no significant differences in the functional or safety outcomes between the extended versus early time window among patients with either IVT, EVT, or IVT plus EVT. There were no signals indicating, that IVT or EVT should be avoided in eligible patients in the extended time window which aligns with the current clinical treatment guidelines of HUS.

Original languageEnglish
Article number123107
JournalJournal of the Neurological Sciences
Volume462
Number of pages6
ISSN0022-510X
DOIs
Publication statusPublished - 15 Jul 2024
MoE publication typeA1 Journal article-refereed

Bibliographical note

Publisher Copyright:
© 2023

Fields of Science

  • Acute ischemic stroke
  • Endovascular thrombectomy
  • Extended time window
  • Intravenous thrombolysis
  • 3124 Neurology and psychiatry

Cite this