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Could the time window be extended for thrombolytic treatment in acute ischemic stroke? The ECASS III trial evaluated the safety and efficacy of intravenous alteplase (tPA) administered between 3 and 4.5 h after symptom onset in patients with acute ischemic stroke. This randomized, double-blind study found that patients receiving alteplase had significantly better functional outcomes at 90 days compared to those receiving a placebo. However, the treatment group also experienced a higher rate of symptomatic intracranial hemorrhage. These results extended the therapeutic window for thrombolytic therapy in selected patients, offering a critical opportunity to improve stroke outcomes.

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Intravenous Thrombolysis Between 3 and 4.5 h After Ischemic Stroke: The ECASS III Trial

  • 章节

  • 发表日期：

    2025年

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  • Jose Chacko,
  • Donald B. Chalfin,
  • Ian Seppelt,
  • Swapnil Pawar,
  • Gagan Brar

摘要

Could the time window be extended for thrombolytic treatment in acute ischemic stroke? The ECASS III trial evaluated the safety and efficacy of intravenous alteplase (tPA) administered between 3 and 4.5 h after symptom onset in patients with acute ischemic stroke. This randomized, double-blind study found that patients receiving alteplase had significantly better functional outcomes at 90 days compared to those receiving a placebo. However, the treatment group also experienced a higher rate of symptomatic intracranial hemorrhage. These results extended the therapeutic window for thrombolytic therapy in selected patients, offering a critical opportunity to improve stroke outcomes.