Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke
Published on: March 26, 2024
The timing of administering intravenous thrombolysis (IVT) before thrombectomy compared with thrombectomy alone is critical, with more rapid administration associated with greater benefits compared with longer times between symptom onset and IVT administration, according to new research. The meta-analysis of six randomized clinical trials included 2,313 patients from 15 countries. Patients – who had an anterior-circulation large-vessel occlusion stroke and were eligible for IVT and thrombectomy – were randomized to IVT plus thrombectomy or thrombectomy alone. The median time from symptom onset to expected IVT administration was 2 hours 28 minutes. While there was a statistically significant association between the time from symptom onset to expected IVT administration and the association of allocated treatment with functional outcomes, the benefit of IVT plus thrombectomy declined with longer times between symptom onset and IVT. The absolute risk difference in likelihood of surviving with functional outcomes (modified Rankin Scale score ≤2) was 9% if IVT was administered within 1 hour, 5% if administered within 2 hours, and 1% within 3 hours. The benefit associated with IVT plus thrombectomy was not statistically significant after 2 hours 20 minutes, and after 3 hours 14 minutes, there was no association.