Some patients with large vessel occlusion strokes may still benefit from thrombolysis even after the traditional 4.5-hour window, new analysis of the TIMELESS trial suggested.
Some patients with large vessel occlusion strokes may still benefit from being given thrombolysis even if they present later than the traditional 4.5-hour time window, new analysis of the TIMELESS trial suggested.compared with placebo. Patients selected for the study presented between 4.5 and 24 hours with an occlusion of the middle cerebral artery or of the internal carotid artery . They also had to have evidence of salvageable tissue as determined on perfusion imaging.
"For years, it has been thought too dangerous to give stroke patients thrombolysis after 4.5 hours, but now we know if we choose the patients appropriately with imaging-based selection, we have a group that we are not going to harm with thrombolysis. The next challenge is to identify which patients are going to benefit," he commented.
The primary endpoint showed a shift in the Rankin disability score toward less disability in the tenecteplase group with a common odds ratio of 1.59 . This observation fits with findings from other studies showing that if thrombolysis is given more time to work, it can bring about a substantial rate of vessel opening before thrombectomy is conducted, he said.
"In this situation, the drug didn't really have time to do very much at all before the thrombectomy, but we think it might be working by dissolving fragments of the clot that are often left after thrombectomy," he suggested. The current results show that, as expected, the ICA occlusions did not benefit from thrombolysis, but surprisingly, the larger M1 occlusions showed a benefit while the smaller M2 occlusions did not, observations that the TIMELESS researchers are still trying to understand.
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