Thrombolysis Timing in Acute Ischemic Stroke

Abstract This chapter appraises the ECASS III trial, which investigated the safety and effectiveness of alteplase for treating acute ischemic stroke within a 3- to 4.5-hour window. ECASS III recruited 821 patients, aged 18 to 80, with acute ischemic stroke symptoms and randomly assigned them to receive either alteplase or placebo. The primary outcome was disability at 90 days, with various neurological scores as secondary outcomes. The results showed that 52.4% of patients in the alteplase group achieved a favorable disability outcome, compared to 45.2% in the placebo group. As a result of this study, the treatment window for thrombolytics in acute ischemic stroke was extended to a 3- to 4.5-hour timeframe.