Acute stroke reperfusion therapy trends in the expanded treatment window era

Ganesh Asaithambi, Xin Tong, Mary G. George, Albert W. Tsai, James M. Peacock, Russell V. Luepker, Kamakshi Lakshminarayan

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21 Scopus citations


Background: The American Heart Association/American Stroke Association (AHA/ ASA) recommended an expansion of the time window for acute ischemic stroke (AIS) reperfusion with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) from 3 to 4.5 hours after symptom onset. We examine rates of IV and intraarterial (IA) reperfusion before and after the recommendations to track guideline adoption in community practice.

Methods: Patients with AIS in the Paul Coverdell National Acute Stroke Registry spanning years 2007-2012 were identified. Trends in rates of IVrt-PAversus IA therapy were examined. Outcomes included symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, ability to ambulate at discharge, and discharge destination.

Results: From 2007 to 2012, there were 182,235 AIS patients (median age, 72 years; 51.5% women) in the database at the time of analysis. AIS patients receiving IV rt-PA increased significantly from 3.7% in 2007 to 5.1% in 2012 in the ≤3 hours time window and from .2% in 2007 to 1.3% in 2012 in the 3-4.5 hours time window (P<.001 for both). There was also a significant increase in the rate of IA therapy between 2007 and 2012 (P<.001). There was a significant decrease in the rate of sICH among patients who received any reperfusion between 2007 and 2012.

Conclusions: There was a trend for increased utilization of IV rt-PA in the 0-3 hours and the 3-4.5 hours time windows, which began around the same time as the publication of AHA/ASA recommendations in 2009. This increase was associated with an increase in IA treatment rates along with a decrease in overall sICH rates for patients receiving any reperfusion.

Original languageEnglish (US)
Pages (from-to)2316-2321
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
StatePublished - Oct 1 2014

Bibliographical note

Publisher Copyright:
© 2014 National Stroke Association.


  • Expanded time window
  • ischemic stroke
  • thrombolysis
  • trend analysis


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