{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:29:20Z","timestamp":1779377360657,"version":"3.53.1"},"reference-count":23,"publisher":"S. Karger AG","issue":"3","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"published-print":{"date-parts":[[2020]]},"abstract":"<b><i>Introduction:<\/i><\/b> The benefit of intravenous thrombolysis (IVT) in wake-up stroke (WUS), stroke of unknown time of onset (SUKO), or when time exceeds 4.5 h from last-seen-normal (LSN) guided by CT perfusion (CTP) or MRI has been recently suggested. However, there is limited information of IVT in those patients in real-world studies. <b><i>Objective:<\/i><\/b> Our aim was to evaluate safety and efficacy of IVT selected by CTP in patients with WUS, SUKO, or stroke of time onset beyond 4.5 h. <b><i>Material and Methods:<\/i><\/b> We studied a prospective cohort of patients who underwent IVT from January 2010 to December 2017. Two groups were defined: standard of care group (SC) included patients with time onset &#x3c;4.5 h and CTP group included patients with WUS, SUKO, or onset beyond &#x3e;4.5 h from LSN with penumbra area in CTP. We evaluated baseline characteristics, functional outcomes according to modified Rankin Scale (mRS) at discharge and at 90 days, and intracranial hemorrhages rates. <b><i>Results:<\/i><\/b> 657 patients were studied: 604 (92%) were treated in the SC group and 53 (8%) in the CTP group. The mean NIHSS score was 9.8 in the CTP group versus 13 in the SC group (<i>p<\/i> = 0.001). Seventeen patients in the CTP group (32.1%) received bridging therapy with mechanical thrombectomy (MT). Last time seen well-to-needle time was 538 versus 155 min (<i>p<\/i> &#x3c; 0.001). The incidence of symptomatic intracranial hemorrhage was equal in both groups (3.8 vs. 3.8%, <i>p<\/i> = 1). Good functional outcome (mRS &#x3c; 2) was achieved in both groups (72 vs. 60.4%, <i>p<\/i> = 0.107). <b><i>Conclusions:<\/i><\/b> IVT in patients with WUS, SUKO, or stroke beyond &#x3e;4.5 h from LSN, with salvageable brain tissue on CTP, seems to be safe and has similar functional outcomes at 90 days to the standard therapeutic window, even when combined with MT. <\/jats:p>","DOI":"10.1159\/000509013","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T21:00:32Z","timestamp":1593723632000},"page":"328-333","source":"Crossref","is-referenced-by-count":8,"title":["Intravenous Thrombolysis Guided by Perfusion CT with Alteplase in &#x3e;4.5 Hours from Stroke Onset"],"prefix":"10.1159","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2862-9586","authenticated-orcid":false,"given":"Manuel","family":"Medina-Rodriguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Millan-Vazquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Zapata-Arriaza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Escudero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Pardo-Galiana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan 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Felix","family":"Ocete-Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Jurado-Serrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Gonzalez-Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Cayuela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Moniche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1161\/str.0000000000000211"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2014.00153"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12388"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013644"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1706442"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1713973"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12160"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1813046"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1804355"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15692-4"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13507"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.576140"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.513358"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1159\/000350200"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000007553"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-014-1116-z"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-015-1299-0"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-011-0944-1"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017673"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25544"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.021961"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019832987"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015150319"}],"container-title":["Cerebrovascular 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