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May 25, 2026Journal of Neurosciences in Rural PracticeOpen Access

Pre-hospital delay, thrombolysis timing, and their impact on functional recovery in acute ischemic stroke

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Why the study?

Timely reperfusion is critical for favorable acute ischemic stroke outcomes, but delays before and after hospital arrival remain common in India.

Does faster reperfusion (DTN ≤60 min and OTN ≤180 min) improve 90-day functional recovery in adults with acute ischemic stroke?

Population

250 consecutive adults with neuroimaging-confirmed acute ischemic stroke receiving reperfusion therapy

Comparison

Pre-hospital delay and door-to-needle time intervals

Design

Single-center prospective observational study

Follow-up

90 days

Key result

Door-to-needle time ≤60 minutes independently increased the odds of a good 90-day functional outcome by more than two-fold (AOR 2.21) in patients with acute ischemic stroke.

Authors

NJNarendra Nath JenaPNParvathy NandyRSRakesh Kumar Saroj

Discussion

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Member takes

Overview

Supports DTN ≤60 min targets in thrombolysis; hypothesis-generating, requires RCTs before practice change.

Study Design

Type

Observational (n=250)

Multicenter

No

Structured PICO

Does faster reperfusion (DTN ≤60 min and OTN ≤180 min) improve 90-day functional recovery in adults with acute ischemic stroke?

P
Population
250 consecutive adults with neuroimaging-confirmed acute ischemic stroke (AIS) receiving reperfusion therapy at a tertiary care center in Tamil Nadu, India.
I
Intervention
Faster reperfusion times (door-to-needle [DTN] time ≤60 min and onset-to-needle [OTN] time ≤180 min) with intravenous alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg), with or without bridging mechanical thrombectomy.
C
Comparator
Slower reperfusion times (DTN >90 min and OTN >270 min).
O
Outcome
Good functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0–2.hard clinical

Main Result

Effect estimate: AOR 2.21 (95% CI 1.33-3.55)

p-value: p=0.002

Faster reperfusion times (door-to-needle ≤60 min and onset-to-needle ≤180 min) significantly improve the odds of good 90-day functional recovery in patients with acute ischemic stroke.

Limitations

  • Conducted at a single tertiary care center, limiting generalizability
  • Observational design cannot establish causal inference
  • Reliance on patient or caregiver report for some pre-hospital variables may introduce recall error
  • Small number of patients undergoing bridging thrombectomy limited subgroup analysis
  • 90-day outcome assessment included telephonic follow-up in a proportion of patients, which may have underestimated subtle residual disability

Cite This Study

Jena et al. (2026) conducted an observational in Acute ischemic stroke (n=250). Door-to-needle (DTN) time ≤60 min vs. Door-to-needle (DTN) time >60 min was evaluated on Good functional outcome (mRS 0-2) at 90 days (AOR 2.21, 95% CI 1.33-3.55, p=0.002). Door-to-needle time ≤60 minutes independently increased the odds of a good 90-day functional outcome by more than two-fold (AOR 2.21) in patients with acute ischemic stroke.

synapsesocial.com/papers/6a176dc38008e5848e6ea1a1https://doi.org/10.25259/jnrp_60_2026
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