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Updated: Jun 20, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolysis beyond 3 hours for acute ischaemic stroke
R Selvaratnam1, U Srirangalingam, S Ahmad
1Department of Medicine, Maidstone General Hospital, Maidstone, Kent ME16 9QQ, UK. rselvaratnam@doctors.org.uk
Emergency Medicine Journal : EMJ
|September 24, 2009
Summary
Successful thrombolysis for acute ischemic stroke is possible beyond 3 hours using advanced imaging and combined IV/IA thrombolysis. This case highlights extended therapeutic windows for stroke treatment.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Intravenous thrombolysis is standard for acute ischemic stroke within 3 hours.
- Emerging evidence supports thrombolysis beyond the 3-hour window.
Purpose of the Study:
- To present a case of successful thrombolysis in a young woman with ischemic stroke beyond 3 hours.
- To review advances in imaging and drug administration for extended therapeutic windows.
Main Methods:
- Case report of a young woman with ischemic stroke.
- Perfusion CT scanning for benefit stratification.
- Combined intravenous and intra-arterial thrombolysis with recombinant tissue-type plasminogen activator.
Main Results:
- Successful thrombolysis was achieved in a patient presenting more than 3 hours after stroke onset.
- Perfusion CT facilitated risk-benefit assessment.
- Combined thrombolysis routes maximized therapeutic benefit.
Conclusions:
- Advanced imaging and combined thrombolysis routes enable successful treatment in extended time windows.
- Consideration of thrombolysis beyond 3 hours in specialized centers is warranted.
- These advances may impact current and future stroke treatment practices.
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