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New research · Neurology
Neurology · 1d
Meta-analysisNeurology · 2026

Exploring Between-Study Heterogeneity in Extended-Window IV Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of 18 Randomized Controlled Trials.

Mohamed F Doheim, Abdullah M Al-Qudah, Romil Singh … Raul G Nogueira
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NeurologyMeta-analysis

Extended-window IV thrombolysis improves excellent functional recovery in acute ischemic stroke.

Exploring Between-Study Heterogeneity in Extended-Window IV Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of 18 Randomized Controlled Trials.

Mohamed F Doheim et al. · Neurology · 2026
Background

IV thrombolysis (IVT) is the standard-of-care evidence-based treatment of eligible patients with acute ischemic stroke (AIS) within 4.5 hours of symptom onset.

Methods

We searched MEDLINE, Cochrane Library, and ClinicalTrials.gov from inception through February 2026.

n = 5,168 patients
Results

extended clot-busting treatment led to a 21% higher chance of excellent recovery from stroke

RR by subgroup · 95% CI
null = 1
ntly improved excellent functional
1.21
good functional outcome
1.09
sICH
1.90
but did not increase 90-day mortality
1.04
More results

Of the 18 included RCTs, 11 required advanced perfusion imaging (CTP or MRP mismatch) or diffusion-weighted imaging/fluid-attenuated inversion recovery mismatch to confirm salvageable tissue; the remaining 7 permitted noncontrast CT/CT angiography-based selection.

More results

IVT was associated with significantly greater odds of reduced disability across the full mRS spectrum (common OR 1.18; 95% CI 1.07-1.32; p = 0.004).

IVT increased the risk of sICH (3.2% vs 1.4%; RR 1.90; 95% CI 1.28-2.84; p = 0.002; number needed to harm = 57) but did not increase 90-day mortality (13.7% vs 13.0% RR 1.04; 95% CI 0.92-1.18; p = 0.53).

“
Conclusion

CLASSIFICATION OF EVIDENCE: This study provides American Academy of Neurology Class I evidence that IVT administered 4.5-24 hours after moderate-to-severe AIS onset in patients with salvageable tissue, where thrombectomy is not readily available, improves functional outcome at 90 days without increasing mortality.

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