Efficacy and Safety of Intravenous Thrombolysis in the Extended Time Window for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

作者：Lina Palaiodimou, Nikolaos M. Papageorgiou, Apostolοs Safouris, Aikaterini Theodorou, Eleni Bakola, Maria Eleni Chondrogianni, Georgia Papagiannopoulou, Odysseas Kargiotis, Klearchos Psychogios, Effie Polyzogopoulou, Georgios Magoufis, Georgios Velonakis, Jobst Rudolf, Panayiotis D. Mitsias, Georgios K. Tsivgoulis · 发表于：Journal of Clinical Medicine · 年份：2025 · DOI：10.3390/jcm14155474 · 被引用次数：12 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Venous Thromboembolism Diagnosis and Management

Background/Objectives: While intravenous thrombolysis (IVT) is the standard treatment for acute ischemic stroke (AIS) within 4.5 h of symptom onset, many patients present beyond this time window. Recent trials suggest that IVT may be both effective and safe in selected patients treated after the standard time window. Methods: We searched MEDLINE, Scopus, and ClinicalTrials.gov for randomized-controlled clinical trials (RCTs) and individual patient-data meta-analyses (IPDMs) of RCTs comparing IVT plus best medical treatment (BMT) to BMT alone in AIS patients who were last-known-well more than 4.5 h earlier. The primary efficacy outcome was a 90-day excellent functional outcome [modified Rankin Scale (mRS)-scores of 0–1]. Secondary efficacy outcomes included good functional outcome (mRS-scores 0–2) and reduced disability (≥1-point reduction across all mRS-strata). The primary safety outcome was symptomatic intracranial hemorrhage (sICH); secondary safety outcomes were any ICH and 3-month all-cause mortality. Subgroup analyses were performed stratified by different thrombolytics, time-windows, imaging modalities, and affected circulation. Results: Nine studies were included, comprising 1660 patients in the IVT-group and 1626 patients in the control-group. IVT significantly improved excellent functional outcome (RR = 1.24; 95%CI:1.14–1.34; I2 = 0%) and good functional outcome (RR = 1.18; 95%CI:1.05–1.33; I2 = 70%). IVT was associated with increased odds of reduced disability (com...