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Background <p><?tk 2?>Across the world, stroke remains a major public health burden, ranking second among causes of death and contributing substantially to disability. The WAKE-UP and the EXTEND trials concluded that in some acute stroke patients, IV thrombolysis (IVT) in the extended window up to 9 h can be beneficial guided by advanced neuroimaging. Updated guidelines increased the time window for endovascular thrombectomy from 6 to 24 h. Studies showed that compared to patients who underwent mechanical thrombectomy (MT) alone, those who underwent mechanical thrombectomy after receiving intravenous thrombolysis had reduced mortality rates, increased success rate for recanalization, fewer procedure-passes, and an equal chance of experiencing symptomatic intracranial hemorrhage (sICH). In the current randomized trial, we planned to focus on administering IVT before undergoing MT in the extended window of cerebrovascular stroke.</p> Methods <p><?tk 2?>50 patients with large vessel occlusion (LVO) stroke who presented within 4.5–9 h were included. Patients were randomly assigned into two groups: the first received IVT prior to MT, while the second group underwent MT only. The National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), collaterals score, Thrombolysis in Cerebral Infarction (TICI) recanalization score, and Heidelberg-bleeding-classification for hemorrhagic transformation were used for assessment.</p> Results <p><?tk 2?>Patients in the combined IVT and MT group showed a significant decrease in NIHSS scores both at discharge and at 3 months post-treatment. At time of discharge mean NIHSS was 10 (8–11) in thrombectomy only group and 4 (2.5–8) in the combined MT + IVT group, whereas at 90 days follow up mean NIHSS was 7 (3.5–8) and 4 (2–7) respectively. Whereas functional independence after 90 days (mRS 0–2) occurred in 72% of combined group opposing to 44% in the MT only group. Hemorrhagic transformation occurred in 80% of the combined group and in 52% of MT only group, however sICH and mortality rates failed to demonstrate significant distinctions from either group.</p> Conclusion <p><?tk 2?>In the extended time window, bridging therapy with IVT and MT may improve functional outcomes, reduce time to recanalization, and increase First Pass Effect (FPE) rates, without raising the risk of sICH or mortality.</p>

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Safety and efficacy of combined thrombolysis and thrombectomy in the extended time window of acute ischemic stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Mostafa Hashim,
  • Ahmed El-Bassiouny,
  • Ayman Hassan El-Sudany,
  • Hany Mohamed Amin Aref,
  • Hossam Shokri,
  • Eman Mones Abushady ,
  • Amr S. Zaki

摘要

Background

Across the world, stroke remains a major public health burden, ranking second among causes of death and contributing substantially to disability. The WAKE-UP and the EXTEND trials concluded that in some acute stroke patients, IV thrombolysis (IVT) in the extended window up to 9 h can be beneficial guided by advanced neuroimaging. Updated guidelines increased the time window for endovascular thrombectomy from 6 to 24 h. Studies showed that compared to patients who underwent mechanical thrombectomy (MT) alone, those who underwent mechanical thrombectomy after receiving intravenous thrombolysis had reduced mortality rates, increased success rate for recanalization, fewer procedure-passes, and an equal chance of experiencing symptomatic intracranial hemorrhage (sICH). In the current randomized trial, we planned to focus on administering IVT before undergoing MT in the extended window of cerebrovascular stroke.

Methods

50 patients with large vessel occlusion (LVO) stroke who presented within 4.5–9 h were included. Patients were randomly assigned into two groups: the first received IVT prior to MT, while the second group underwent MT only. The National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), collaterals score, Thrombolysis in Cerebral Infarction (TICI) recanalization score, and Heidelberg-bleeding-classification for hemorrhagic transformation were used for assessment.

Results

Patients in the combined IVT and MT group showed a significant decrease in NIHSS scores both at discharge and at 3 months post-treatment. At time of discharge mean NIHSS was 10 (8–11) in thrombectomy only group and 4 (2.5–8) in the combined MT + IVT group, whereas at 90 days follow up mean NIHSS was 7 (3.5–8) and 4 (2–7) respectively. Whereas functional independence after 90 days (mRS 0–2) occurred in 72% of combined group opposing to 44% in the MT only group. Hemorrhagic transformation occurred in 80% of the combined group and in 52% of MT only group, however sICH and mortality rates failed to demonstrate significant distinctions from either group.

Conclusion

In the extended time window, bridging therapy with IVT and MT may improve functional outcomes, reduce time to recanalization, and increase First Pass Effect (FPE) rates, without raising the risk of sICH or mortality.