Key result
Tenecteplase beyond 4.5 hours boosts excellent functional recovery ~47% in ischemic stroke despite higher sICH.
Why the study?
Does intravenous thrombolysis improve functional outcomes in patients with ischemic stroke beyond the 4.5-hour window?
Meta-Analysis
Does intravenous thrombolysis improve functional outcomes in patients with ischemic stroke beyond the 4.5-hour window?
Intravenous thrombolysis beyond the 4.5-hour window improves functional outcomes in ischemic stroke patients, though it is associated with an increased risk of symptomatic intracranial hemorrhage.
BACKGROUND: A minority of patients with stroke qualify for intravenous thrombolysis (IVT) within 4.5-hour window. The safety and efficacy of IVT beyond this period have not been well studied. METHODS: ² values. Subanalyses yielded numerically higher odds of excellent functional outcomes when patients were selected with perfusion imaging (3 studies, OR, 1.45 [95% CI, 1.08-1.94]) compared with diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch (3 studies, OR, 1.34 [95% CI, 0.94-1.91]) and when treated with tenecteplase (3 studies, OR, 1.47 [95% CI, 1.06-2.04]) compared with alteplase (5 studies, OR, 1.38 [95% CI, 1.08-1.78]). CONCLUSIONS: IVT for ischemic stroke beyond 4.5 hours, without MT, led to increased odds of excellent and good functional outcomes compared with standard medical care, despite higher odds of sICH, and a nonsignificant numerical increase in mortality.
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Günkan et al. (2025) conducted a meta-analysis in Ischemic stroke. Intravenous thrombolysis (IVT) vs. Standard medical care was evaluated on Excellent and good functional outcomes. Intravenous thrombolysis for ischemic stroke beyond 4.5 hours increased excellent functional outcomes, particularly with tenecteplase (OR 1.47; 95% CI 1.06-2.04), despite higher odds of sICH.
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