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ESOC 2025 | A real-world study on the use of IVT in extended time window, with or without thrombectomy, for AIS

Cristina Del Valle Vargas, MD, University of Barcelona, Barcelona, Spain, comments on a real-world multicenter study in Catalonia examining the use of intravenous thrombolysis (IVT) within an extended time window, with or without thrombectomy, for the treatment of acute ischemic stroke (AIS). The study found that patients treated with IVT within the extended time window had similar clinical outcomes to those treated within the conventional time window. However, those who received IVT plus mechanical thrombectomy had a higher mortality rate in the extended time window. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.

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Transcript

Since the approval of thrombolysis for the treatment of acute stroke, different research groups have aimed to expand its indications to allow more patients to securely benefit from its effects. One of the main goals has been to expand the time window. Current recommendations for IVT in the extended time window follow the criteria of pivotal studies like the extended study for which the evidence of the recommendation is moderate to low...

Since the approval of thrombolysis for the treatment of acute stroke, different research groups have aimed to expand its indications to allow more patients to securely benefit from its effects. One of the main goals has been to expand the time window. Current recommendations for IVT in the extended time window follow the criteria of pivotal studies like the extended study for which the evidence of the recommendation is moderate to low. So our study is about a real-life cohort in which we try to see the clinical outcome or describe the clinical outcome of the treatment of IVT in the extended time window with and without thrombectomy. It’s an observational multicenter study using a prospective registry of patients with stroke code activation in Catalonia, which is known as the CICAT, and the time window that we use is from January 2017 until December 2022. The patients that received IVT in the extended time window were 539. We divided them basically into groups: those that receive IVT alone and those that receive IVT plus mechanical thrombectomy, which is known as bridge therapy. So the ones that receive only IVT, we compared them with those that receive IVT in the conventional time window, and for this, the clinical outcomes that we use for efficacy were Rankin scale at 90 days zero to one or return to previous Rankin scale status, and for safety, mortality or symptomatic intracranial hemorrhage. For the patients that receive only IVT in the extended time window, these results were the same as the ones in the conventional time window, so these real-life outcomes or results from our cohort are aligned with the recommendations and reinforce the recommendations that have this moderate to low evidence. For the other analysis with the bridge therapy, our results for efficacy were the same in both groups, extended time window and conventional time window, but for safety, in the extended time window group, there was a higher percentage of mortality, so maybe for bridge in the extended time window, we need still a little bit more evidence and real-life practice.

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