Stroke thrombolysis at 5.5 hours based on computed tomography perfusion.

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Acute ischemic stroke requires timely reperfusion therapy.
• The standard treatment window for intravenous thrombolysis is 4.5 hours from symptom onset.
• Assessing brain tissue viability, particularly the penumbra, may extend treatment eligibility.

Purpose of the Study:

• To evaluate the impact of a significant penumbra on neurological recovery in stroke patients treated with rtPA outside the standard time window.
• To determine if the extent of the penumbra is a key factor for successful thrombolysis outcomes.

Main Methods:

• A case study of a young male patient presenting with acute ischemic stroke and left middle cerebral artery occlusion.
• Computed tomography (CT) perfusion imaging was used to quantify the infarct core and penumbra.
• Intravenous recombinant tissue plasminogen activator (rtPA) was administered 5.5 hours after symptom onset due to a large penumbra (approx. 50%).

Main Results:

• The patient received rtPA 5.5 hours post-symptom onset.
• Despite initial significant residual deficit, the patient achieved near-complete recovery at 2 months (Modified Rankin Score of 1).
• The large penumbra identified on CT perfusion was associated with a favorable outcome.

Conclusions:

• A significant penumbra can be a critical factor for good neurological recovery in stroke patients treated with thrombolysis, even beyond the 4.5-hour window.
• CT perfusion imaging is valuable for identifying eligible patients for thrombolysis based on tissue viability.
• Individualized treatment decisions considering penumbra size may improve outcomes in selected stroke patients presenting late.