{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:59:02Z","timestamp":1785178742040,"version":"3.55.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"name":"EC | HORIZON EUROPE Framework Programme","award":["101057603"],"award-info":[{"award-number":["101057603"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Randomized evidence suggests that the association of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) may be time-dependent. We evaluated whether treatment timing modifies the association of IVT+EVT versus EVT alone with short-term in-hospital outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a multinational observational registry cohort study using RES-Q (Registry of Stroke Care Quality) data (2022\u20132024) from 38 countries. Among 3132 eligible anterior-circulation large-vessel occlusion patients treated with EVT, 3009 comprised the analytic cohort (IVT+EVT or EVT alone). The primary outcome was the ordinal modified Rankin Scale (mRS) score at discharge; secondary outcomes were the mRS score 0 to 2 at discharge and in-hospital survival. Time strata were \u2264100, &gt;100 to 150, &gt;150 to 255, and &gt;255 minutes. Confounding was addressed with stabilized inverse probability of treatment weighting (weights truncated at 10) using a propensity score including arrival mode, admission location\/department, vascular risk factors (hypertension, diabetes, hyperlipidemia, atrial fibrillation, prior stroke, smoking), imaging type, and baseline National Institutes of Health Stroke Scale score. For EVT-only patients, onset-to-needle time was predicted only to assign time strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The mean age was 69.2 years (SD, 13.2), and 45.6% were female. Treatment-by-time interaction was significant for ordinal discharge mRS score (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002) and mRS score 0 to 2 at discharge (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02). IVT+EVT was associated with better outcomes in the earliest treatment windows: at \u2264100 minutes, ordinal mRS score odds ratio (OR) 1.99 (95% CI, 1.49\u20132.63), in-hospital survival OR, 1.81 (95% CI, 1.13\u20132.92), and mRS score 0 to 2 OR, 1.76 (95% CI, 1.24\u20132.51); at &gt;100 to 150 minutes, ordinal mRS score OR, 1.58 (95% CI, 1.21\u20132.06) and mRS score 0 to 2 OR, 1.64 (95% CI, 1.16\u20132.31). Associations were attenuated beyond 150 minutes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In routine practice, early IVT before EVT was most consistently associated with improved discharge outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055656","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:00:09Z","timestamp":1778065209000},"page":"2315-2324","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Time-Dependent Efficacy of Thrombolysis Before Thrombectomy: RES-Q"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7458-5166","authenticated-orcid":true,"given":"Robert","family":"Mikulik","sequence":"first","affiliation":[{"name":"Stroke Research Program, International Clinical Research Center, St Anne\u2019s University Hospital, Brno, Czech Republic (R.M., G.N., S.T.)."},{"name":"Department of Neurology, Krajsk\u00e1 nemocnice T. Bati, a. s., Zl\u00edn, Czech Republic (R.M.)."},{"name":"Health Management Institute, z.u., Brno, Czech Republic (R.M., G.N., R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6201-2080","authenticated-orcid":true,"given":"Geraldo","family":"Neto","sequence":"additional","affiliation":[{"name":"Stroke Research Program, International Clinical Research Center, St Anne\u2019s University Hospital, Brno, Czech Republic (R.M., G.N., S.T.)."},{"name":"Health Management Institute, z.u., Brno, Czech Republic (R.M., G.N., R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6103-3479","authenticated-orcid":true,"given":"Rupal","family":"Sedani","sequence":"additional","affiliation":[{"name":"Health Management Institute, z.u., Brno, Czech Republic (R.M., G.N., R.S.)."},{"name":"World Stroke Organization, Geneva, Switzerland (R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-8317","authenticated-orcid":true,"given":"Sandra","family":"Thalerov\u00e1","sequence":"additional","affiliation":[{"name":"Stroke Research Program, International Clinical Research Center, St Anne\u2019s University Hospital, Brno, Czech Republic (R.M., G.N., S.T.)."},{"name":"Department of Biophysics of Immune System, Institute of Biophysics of the Czech Academy of Sciences, Brno, Czech Republic (S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4442-8637","authenticated-orcid":true,"given":"Natan M.","family":"Bornstein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-5052","authenticated-orcid":true,"given":"Zuzana","family":"Gdovinov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, P.J. Safarik University and University Hospital L. Pasteur, Ko\u0161ice, Slovakia (Z.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":true,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (M.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warszawa, Poland (A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9118-9093","authenticated-orcid":true,"given":"Pablo M.","family":"Lavados","sequence":"additional","affiliation":[{"name":"Servicio de Neurolog\u00eda, Departamento de Neurolog\u00eda y Psiquiatr\u00eda, Cla, Departamento de Neurolog\u00eda y Psiquiatr\u00eda, Cl\u00ednica Alemana de Santiago, Facultad de Medicina Clnica Alemana de Santiago, Facultad de Medicina Cl\u00ednica Alemana Universidad del Desarrollonica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8452-712X","authenticated-orcid":true,"given":"Sheila","family":"Martins","sequence":"additional","affiliation":[{"name":"Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S. Martins)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9910-1538","authenticated-orcid":true,"given":"Sandy","family":"Middleton","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia (S. Middleton)."},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia (S. Middleton)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4862-6726","authenticated-orcid":true,"given":"Evija","family":"Miglane","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Pauls Stradins Clinical University Hospital, Riga Stradins University, Latvia (E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6057-8379","authenticated-orcid":true,"given":"Huy-Thang","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Stroke Center, The People\u2019s 115 Hospital, and Department of Neurology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam (H.-T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6900-1242","authenticated-orcid":true,"given":"Sung-Il","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea (S.-I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6393-110X","authenticated-orcid":true,"given":"Nijasri C.","family":"Suwanwela","sequence":"additional","affiliation":[{"name":"Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, and Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (N.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4896-8275","authenticated-orcid":true,"given":"P.N.","family":"Sylaja","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India 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