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Area of Science:

  • Neurology
  • Vascular Medicine
  • Emergency Medicine

Background:

  • Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are primary treatments for acute ischemic stroke.
  • Alteplase (rtPA) has been the standard for IVT, with tenecteplase (TNK) emerging as a comparable alternative.
  • EVT has become a highly effective treatment over the last decade, particularly for large vessel occlusions.

Purpose of the Study:

  • To compare the efficacy and application of IVT and EVT in acute ischemic stroke management.
  • To highlight the time-sensitive nature of stroke recanalization therapies.
  • To discuss patient selection criteria and resource implications for both IVT and EVT.

Main Methods:

  • Review of current literature on IVT and EVT for acute ischemic stroke.
  • Analysis of pharmacological properties and clinical outcomes of rtPA and TNK.
  • Examination of established and extended time windows for IVT and EVT.
  • Discussion of advanced imaging techniques for patient selection in EVT.

Main Results:

  • Tenecteplase (TNK) is non-inferior to alteplase (rtPA) and may offer earlier recanalization, especially in large vessel occlusions.
  • IVT has an optimal time window of 4.5 hours, extendable to 9 hours with advanced imaging.
  • EVT has a time window up to 24 hours, with potential for use beyond this in selected cases.
  • EVT requires specialized centers and personnel, while IVT is more widely accessible.

Conclusions:

  • Both IVT and EVT are crucial for acute ischemic stroke, with TNK offering potential advantages over rtPA.
  • Optimal patient selection using advanced imaging is vital for EVT, particularly for large vessel occlusions.
  • Combining IVT and EVT within the 4.5-hour window offers the best outcomes for eligible patients.
  • Standard operating procedures are essential for timely administration of these time-critical stroke therapies.