Guidelines currently limit time to initiate thrombolytic therapy in acute stroke to 4.5 hours after symptom onset. In contrast, endovascular thrombectomy has been shown to improve outcomes in patients with salvageable brain tissue on imaging studies up to 24 hours after the onset of symptoms. The use of tissue viability as the guide to thrombectomy has also led to better outcomes compared to selection based on time of onset. This study hypothesized that extending the time window for thrombolytic therapy to 9 hours after onset of symptoms in patients with a small core of infarction and a larger area of hypoperfusion would be beneficial.
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