(Open access funding provided by Semmelweis University)
Current European Stroke Organisation (ESO) guidelines recommend extended time window
reperfusion therapies (4.5–9 h for thrombolysis, 6–24 h for thrombectomy) based on
advanced imaging. However, the workload and clinical benefit of this strategy on a
population basis are not known. To determine the caseload, treatment rates, and outcomes
in the extended as compared to the standard time windows. All consecutive ischaemic
stroke patients within 24 h of last known well between 1st March 2021 and 28th February
2022 were included in a prospective single-centre study. Treatment eligibility in
the extended time windows or wake-up strokes recognized within 4 h was based on current
ESO guideline criteria using MRI DWI-PWI or DWI-FLAIR mismatch. MRI was only available
during working hours (8–20 h); otherwise, CT/CTA was used. Clinical outcome in treated
patients was assessed at three months. Among the 777 admitted patients, 252 (32.4%)
had MRI. The thrombolysis rate was 119/304 (39.1%) in standard and 14/231 (6.1%) in
the extended time window. The thrombectomy rate was 34/386 (8.8%) in standard and
15/391 (3.8%) in the extended time window. Independent clinical outcomes (mRS ≤ 2)
were not statistically different in early and late-treated patients both for thrombolysis
(48% vs. 28.6%, p = 0.25) and thrombectomy (38.4% vs. 33.3%, p = 0.99). Even with
a limited availability of advanced imaging extending therapeutic time windows resulted
in an 11.7% increase in thrombolysis and a 44% increase in thrombectomy with comparable
clinical outcomes in early and late-treated patients at the price of a twofold burden
in clinical and advanced imaging screening.
