ABSTRACT NUMBER: ESOC2026A2333 USE OF THROMBOLYSIS TREATMENT IN THE EXTENDED TIME WINDOW IN ROUTINE CLINICAL PRACTICE: A REAL-WORLD COHORT STUDY

Abstract Background and aims Reperfusion therapies in the extended time window have been established by randomized trials using advanced imaging–based selection. However, data on the real-world frequency of extended time window (ETW) thrombolysis treatment and their clinical outcome compared with conventional time window (CTW) interventions remain limited. Methods We analyzed a consecutive real-world cohort of 594 acute ischemic stroke patients treated with intravenous thrombolysis (IVT) plus endovascular treatment (EVT) at a comprehensive stroke center. Patients treated in the ETW were identified and descriptively compared with those treated within the conventional window. Baseline clinical severity, imaging use, complications, and functional outcomes up to 12 months were assessed. Results Among all treated patients, 18% received a thrombolysis in the extended time window (IVT in 64.5%, IVT + EVT in 35.5%). Advanced imaging was widely implemented, with CT perfusion performed in 74.6% of the overall cohort. Baseline stroke severity was comparable between extended- and conventional-window patients, with similar median NIHSS scores (16 in ETW vs 14 in CTW; p=0.353). Functional outcomes, assessed by the modified Rankin Scale, showed no significant differences between groups at 3 and 12 months. Moreover, symptomatic intracerebral hemorrhage (1.9% in ETW vs. 5.4% in CTW) and early mortality (2.8% in ETW vs. 4.2% in CTW) were comparable. Conclusions In our routine clinical practice, thrombolysis was widely used in the ETW reaching 18% compared to the 4-5% of the reported literature. In our cohort, functional outcomes were comparable to those observed in the conventional window and in the literature. Conflict of interest Emanuele Vincis: Nothing to disclosure. Marcello Naccarato: Nothing to disclosure. Edoardo Ricci: Nothing to disclosure. Magda Quagliotto: Nothing to disclosure. Michele Malesani: Nothing to disclosure. Gianpiero Farina: Nothing to disclosure. Paola Caruso: Nothing to disclosure. Giovanni Furlanis: Nothing to disclosure. Paolo Manganotti: Nothing to disclosure.