Ultraearly repeated systemic thrombolysis in recurrent ischemic stroke - A multicentre case study

Area of Science:

• Neurology
• Vascular Neurology
• Emergency Medicine

Background:

• Ischemic stroke recurrence within 10 days is a critical clinical challenge.
• Off-label repeated thrombolysis is an emerging strategy for ultraearly stroke recurrence.
• Recombinant tissue plasminogen activator (rt-PA) is a key thrombolytic agent.

Purpose of the Study:

• To analyze the outcomes of patients receiving off-label ultraearly repeated thrombolysis (UERT) for ischemic stroke recurrence.
• To evaluate the efficacy and safety of UERT in a real-world setting.
• To assess the rate of early clinical improvement and favorable outcomes following UERT.

Main Methods:

• Retrospective multicentric case study.
• Identification of patients from the TEMPiS registry and database searches (PubMed, Google Scholar).
• Analysis of demographic, clinical, laboratory, and imaging data, with author contact for details.

Main Results:

• Sixteen patients received UERT, with a median time of 3.5 days between treatments.
• 85.7% of patients showed early clinical improvement (NIHSS reduction ≥4).
• 68.8% achieved a favorable outcome (mRS 0-2 at 3 months); 25.0% experienced intracerebral hemorrhage (ICH), with one fatal event.

Conclusions:

• UERT demonstrated significant early clinical improvement and favorable outcomes in patients with early recurrent ischemic stroke.
• ICH rates were comparable to existing publications, suggesting a manageable risk profile.
• UERT may be considered in select patients with early recurrent stroke following careful risk-benefit assessment.