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Abstract Details

Thrombolytic Therapy in Extended Window with only Non-contrast Computed Tomography: A Systematic Review and Meta-analysis
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:00 PM-6:00 PM)
4-019
This study aimed to comprehensively review and analyze clinical trials and observational studies regarding Thrombolytic Therapy for Acute Ischemic Stroke (AIS) in an extended window using only Non-Contrast Computed Tomography (NCCT).
Recently, Thrombolytic Therapy has been proposed as an effective and safe measure for patients who arrive beyond the 4.5 hours of symptoms onset, Wake Up Stroke (WUS), or with unknown onset of symptoms (UOS), improving functional outcomes without increasing mortality in this population, when selected with perfusion imaging. However, these imaging modalities are often not available in low-resource settings.
We conducted a systematic review of PubMed, Embase, Wiley Online, and Web of Science, searching for either Clinical Trials or Observational studies that compared Thrombolytic Therapy against standard care in patients with AIS arriving beyond 4.5 hours of Symptoms, WUS, or UOS using only NCCT. P value was significant at 0.05. Stata SE. 18.0 was used for statistical analysis.
From 874 records, 11 studies met inclusion criteria for the systematic review. Three studies compared IVT versus standard care in the extended window, and were eligible for meta-analysis. For functional independence (modified Rankin score 0-2), it resulted in a pooled odds ratio of 0.16 (95% CI: 0.07–0.38; I² = 92.8%, τ² = 0.04, p-value = 0.170, n = 1349), favoring thrombolysis. Moreover, there is no statistically significant increase in intracranial hemorrhage with treatment compared to control (OR = 0.02, 95% CI: 0.00 - 0.03, I² = 0.0%, τ² = 0.00, p-value = 0.070, n = 876).

Thrombolysis guided by NCCT in the extended window appears potentially effective and safe. These findings may help expand access to thrombolytic therapy in low-resource settings and should be evaluated in larger, prospective trials.

Keywords: Acute Ischemic Stroke, Thrombolytic Therapy, Extended Window, Wake Up Stroke, Stroke of Unknown Onset, Non-Contrast Computed Tomography
Authors/Disclosures
Juan D. Oyola, MD
PRESENTER 		Dr. Oyola has nothing to disclose.
Juan D. Martinez Lemus, MD (The University of Texas Health Science Center at Houston) Dr. Martinez Lemus has nothing to disclose.
Victória Siebel Victória Siebel has nothing to disclose.
Claudio A. Monsalve, MD Mr. Monsalve has nothing to disclose.
Hernan Bayona, MD (Independent) Dr. Bayona has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Aventis. Dr. Bayona has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringer-Ingelheim. Dr. Bayona has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Bayer SA. Dr. Bayona has received publishing royalties from a publication relating to health care.