Case series of successful thrombolytic therapy with the recombinant non-immunogenic staphylokinase in acute ischemic stroke beyond the standard therapeutic window

A series of clinical cases of the use of a non-immunogenic staphylokinase drug (Fortelyzin, SuperGene LLC, Russia) within an extended therapeutic window (4.5-9 hours) in accordance with the EXTEND criteria in the neurological department of the Sverdlovsk Regional clinical hospital No. 1 during 2023 is presented. During therapy, all patients showed significant regression of neurological deficits both on the first day after TLT and by the time of discharge (NIHSS dynamics of more than 5 points), good functional outcomes were achieved (0-2 points on the mRS scale), there was no hemorrhagic transformation on the control CT. TLT with non-immunogenic staphylokinase in accordance with the EXTEND criteria demonstrated a favorable the effectiveness and safety profile in the presented cases. Further multicenter studies are needed to evaluate its application in the extended window. A paradigm shift from a «temporary» to a «tissue» therapeutic window based on perfusion neuroimaging is a promising direction.