Treating Ischemic Stroke with Intravenous tPA Beyond 4.5 Hours

Overview

IV-tPA is the main thrombolytic agent used to treat acute ischemic stroke, but less than 23% of the patients coming to the ER are eligible to receive it and this is mainly related to the short time window for it which is 4.5 hours only.
In the last few years, many trials tried to extend the time window to increase the number of patients receiving and benefiting from it, and the latest European stroke recommendations did extend the time window to 9 hours.
We will discuss the trials that addressed this issue and review the latest guidelines regarding the tPA window.