{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:09:37Z","timestamp":1779145777511,"version":"3.51.4"},"reference-count":33,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007252","name":"Baugarten Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007252","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008481","name":"Kurt and Senta Herrmann Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008481","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The American Journal of Emergency Medicine"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1016\/j.ajem.2026.04.004","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T15:15:34Z","timestamp":1775315734000},"page":"88-94","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Closing the treatment gap: Identifying current barriers to thrombolysis in acute ischemic stroke within the treatment time window"],"prefix":"10.1016","volume":"105","author":[{"given":"Cinzia","family":"Zehnder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Morra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Globas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsolt","family":"Kulcsar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas R.","family":"Luft","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Wegener","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura P.","family":"Westphal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajem.2026.04.004_bb0005","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1056\/NEJMoa0804656","article-title":"Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke","volume":"359","author":"Hacke","year":"2008","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajem.2026.04.004_bb0010","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1161\/STROKEAHA.119.025080","article-title":"Evidence that tenecteplase is noninferior to alteplase for acute ischemic stroke: Meta-analysis of 5 randomized trials","volume":"50","author":"Burgos","year":"2019","journal-title":"Stroke"},{"key":"10.1016\/j.ajem.2026.04.004_bb0015","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s10072-018-3644-3","article-title":"Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome","volume":"40","author":"Bandettini Di Poggio","year":"2019","journal-title":"Neurol Sci"},{"key":"10.1016\/j.ajem.2026.04.004_bb0020","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1212\/WNL.0000000000002695","article-title":"Restriction of therapy mainly explains lower thrombolysis rates in reduced stroke service levels","volume":"86","author":"Gumbinger","year":"2016","journal-title":"Neurology"},{"key":"10.1016\/j.ajem.2026.04.004_bb0025","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci15080832","article-title":"Acute ischemic stroke treatment in Germany (2015\u20132023): nationwide trends in thrombolysis and thrombectomy by age and sex","volume":"15","author":"Hirsch","year":"2025","journal-title":"Brain Sci"},{"key":"10.1016\/j.ajem.2026.04.004_bb0030","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2017.00341","article-title":"Diurnal variation of intravenous thrombolysis rates for acute ischemic stroke and associated quality performance parameters","volume":"8","author":"Reuter","year":"2017","journal-title":"Front Neurol"},{"key":"10.1016\/j.ajem.2026.04.004_bb0035","doi-asserted-by":"crossref","first-page":"I","DOI":"10.1177\/2396987321989865","article-title":"European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur Stroke J"},{"key":"10.1016\/j.ajem.2026.04.004_bb0040","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/WCO.0000000000001004","article-title":"Intravenous thrombolysis for acute ischemic stroke: why not?","volume":"35","author":"Psychogios","year":"2022","journal-title":"Curr Opin Neurol"},{"key":"10.1016\/j.ajem.2026.04.004_bb0045","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/1747493019840938","article-title":"Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection","volume":"14","author":"Ringleb","year":"2019","journal-title":"Int J Stroke"},{"key":"10.1016\/j.ajem.2026.04.004_bb0050","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1056\/NEJMoa1813046","article-title":"Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke","volume":"380","author":"Ma","year":"2019","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajem.2026.04.004_bb0055","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0140-6736(19)31053-0","article-title":"Extending thrombolysis to 4\u00b75\u20139 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data","volume":"394","author":"Campbell","year":"2019","journal-title":"Lancet"},{"key":"10.1016\/j.ajem.2026.04.004_bb0060","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJMoa1804355","article-title":"MRI-guided thrombolysis for stroke with unknown time of onset","volume":"379","author":"Thomalla","year":"2018","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajem.2026.04.004_bb0065","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1136\/emermed-2015-205140","article-title":"Reasons and evolution of non-thrombolysis in acute ischaemic stroke","volume":"34","author":"Reiff","year":"2017","journal-title":"Emerg Med J"},{"key":"10.1016\/j.ajem.2026.04.004_bb0070","article-title":"Rates of intravenous thrombolysis and endovascular therapy for acute ischaemic stroke in China between 2019 and 2020","volume":"21","author":"Ye","year":"2022","journal-title":"Lancet Reg Health \u2013 West Pac"},{"key":"10.1016\/j.ajem.2026.04.004_bb0075","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/ane.13622","article-title":"Reasons and predictors of non-thrombolysis in patients with acute ischemic stroke admitted within 4.5 h","volume":"146","author":"Bergh","year":"2022","journal-title":"Acta Neurol Scand"},{"key":"10.1016\/j.ajem.2026.04.004_bb0080","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"10.1016\/j.ajem.2026.04.004_bb0085","article-title":"Acute revascularization in ischemic stroke: updated swiss guidelines","volume":"5","author":"Michel","year":"2021","journal-title":"Clin Transl Neurosci"},{"key":"10.1016\/j.ajem.2026.04.004_bb0115","first-page":"575","article-title":"Direct oral anticoagulants in emergency trauma admissions","volume":"113","author":"Maegele","year":"2016","journal-title":"Dtsch \u00c4rztebl Int"},{"key":"10.1016\/j.ajem.2026.04.004_bb0120","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1161\/STROKEAHA.124.047071","article-title":"Rural hospital performance in guideline-recommended ischemic stroke thrombolysis, secondary prevention, and outcomes","volume":"55","author":"Man","year":"2024","journal-title":"Stroke"},{"key":"10.1016\/j.ajem.2026.04.004_bb0125","doi-asserted-by":"crossref","DOI":"10.7759\/cureus.64034","article-title":"Acute stroke in the emergency department: profiles of patients and obstacles to acute intervention","author":"Bosco","year":"2024","journal-title":"Cureus"},{"key":"10.1016\/j.ajem.2026.04.004_bb0130","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3389\/fneur.2016.00086","article-title":"Minor stroke and transient ischemic attack: research and practice","volume":"7","author":"Yakhkind","year":"2016","journal-title":"Front Neurol"},{"key":"10.1016\/j.ajem.2026.04.004_bb0135","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1161\/STROKEAHA.109.572883","article-title":"What is a minor stroke?","volume":"41","author":"Fischer","year":"2010","journal-title":"Stroke"},{"key":"10.1016\/j.ajem.2026.04.004_bb0140","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4236\/nm.2021.121004","article-title":"A new point of consideration for the definition of minor ischemic stroke: review","volume":"12","author":"Fernandes","year":"2021","journal-title":"Neurosci Med"},{"key":"10.1016\/j.ajem.2026.04.004_bb0090","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000431187","article-title":"Can 90-day NIHSS be used for outcome assessment in TIA and minor stroke studies?","volume":"40","author":"Dubuc","year":"2015","journal-title":"Cerebrovasc Dis"},{"key":"10.1016\/j.ajem.2026.04.004_bb0145","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.06.564","article-title":"Zero on the NIHSS does not equal the absence of stroke","volume":"57","author":"Martin-Schild","year":"2011","journal-title":"Ann Emerg Med"},{"key":"10.1016\/j.ajem.2026.04.004_bb0150","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1007\/s10072-012-1205-8","article-title":"A practical definition of minor stroke","volume":"34","author":"Crespi","year":"2013","journal-title":"Neurol Sci"},{"key":"10.1016\/j.ajem.2026.04.004_bb0155","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1001\/jama.2018.8496","article-title":"Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial","volume":"320","author":"Khatri","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.ajem.2026.04.004_bb0160","doi-asserted-by":"crossref","DOI":"10.1016\/j.rpth.2023.102307","article-title":"Acute ischemic stroke and measurement of apixaban and rivaroxaban: an observational cohort implementation study","volume":"8","author":"Amundsen","year":"2024","journal-title":"Res Pract Thromb Haemost"},{"key":"10.1016\/j.ajem.2026.04.004_bb0165","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.thromres.2020.09.002","article-title":"Apixaban and rivaroxaban anti-Xa level utilization and associated bleeding events within an academic health system","volume":"196","author":"Jakowenko","year":"2020","journal-title":"Thromb Res"},{"key":"10.1016\/j.ajem.2026.04.004_bb0170","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamaneurol.2022.4782","article-title":"Intravenous thrombolysis in patients with ischemic stroke and recent ingestion of direct oral anticoagulants","volume":"80","author":"Meinel","year":"2023","journal-title":"JAMA Neurol"},{"key":"10.1016\/j.ajem.2026.04.004_bb0175","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejrad.2022.110455","article-title":"Associations between early ischemic signs on non-contrast CT and time since acute ischemic stroke onset: a scoping review","volume":"155","author":"Van Poppel","year":"2022","journal-title":"Eur J Radiol"},{"key":"10.1016\/j.ajem.2026.04.004_bb0180","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1161\/STROKEAHA.114.005644","article-title":"Time and diffusion lesion size in major anterior circulation ischemic strokes","volume":"45","author":"Hakimelahi","year":"2014","journal-title":"Stroke"},{"key":"10.1016\/j.ajem.2026.04.004_bb0185","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1161\/STROKEAHA.117.017673","article-title":"Fast versus slow progressors of infarct growth in large vessel occlusion stroke","volume":"48","author":"Rocha","year":"2017","journal-title":"Stroke"}],"container-title":["The American Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0735675726001683?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0735675726001683?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:25:45Z","timestamp":1779143145000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0735675726001683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":33,"alternative-id":["S0735675726001683"],"URL":"https:\/\/doi.org\/10.1016\/j.ajem.2026.04.004","relation":{},"ISSN":["0735-6757"],"issn-type":[{"value":"0735-6757","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Closing the treatment gap: Identifying current barriers to thrombolysis in acute ischemic stroke within the treatment time window","name":"articletitle","label":"Article Title"},{"value":"The American Journal of Emergency Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajem.2026.04.004","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}