Effectiveness and Safety of Reperfusion Therapy for Acute Ischemic Stroke Within Extended Time Windows: A Real-World Study from China

<title>Abstract</title> <p>Objectives This study aimed to evaluate the effectiveness and safety of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) presenting 4.5-9 hours after symptom onset, and endovascular thrombectomy (EVT) in patients with large-vessel occlusion ischemic stroke (LVO-IS) presenting 6–24 hours after onset, in routine clinical practice in China. Methods Patients with AIS were retrospectively reviewed between June 2023 and January 2025. Participants were categorized into two groups according to treatment modality: the IVT group and the EVT group. Within each group, patients were further stratified into a standard-window subgroup (SW) and an extended-window subgroup (EW) based on the time from symptom onset to treatment initiation. Neurological deficits were assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were evaluated using the modified Rankin Scale (mRS). Multivariable logistic regression and inverse probability of treatment weighting (IPTW) based on propensity scores were applied to analyze outcomes, including functional independence (mRS 0–1 in the IVT group and mRS 0–2 in the EVT group) at 3 and 6 months, as well as symptomatic intracerebral hemorrhage (sICH) and all-cause mortality. Results A total of 434 patients with AIS who underwent either IVT or EVT were included. After adjustment for potential confounders, multivariable logistic regression analysis showed no significant differences between the SW and EW groups across all outcome measures, regardless of treatment modality. Specifically, no statistically significant differences were observed in functional independence at 3 and 6 months, mortality, or the risk of sICH (all P &gt; 0.05). Conclusion In real-world clinical settings, among AIS patients selected using multimodal imaging, no significant differences were observed between extended-window treatment (IVT and EVT) and standard-window treatment in terms of functional outcomes and safety.</p>