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@ARTICLE{Feil:140918,
      author       = {Feil, K. and Reidler, P. and Kunz, W. G. and Küpper, C.
                      and Heinrich, J. and Laub, C. and Müller, K. and Vöglein,
                      J. and Liebig, T. and Dieterich, M. and Kellert, L.},
      title        = {{A}ddressing a real-life problem: treatment with
                      intravenous thrombolysis and mechanical thrombectomy in
                      acute stroke patients with an extended time window beyond
                      4.5 h based on computed tomography perfusion imaging.},
      journal      = {European journal of neurology},
      volume       = {27},
      number       = {1},
      issn         = {1351-5101},
      address      = {Oxford},
      publisher    = {Blackwell Science78889},
      reportid     = {DZNE-2020-07240},
      pages        = {168-174},
      year         = {2020},
      abstract     = {Acute ischemic stroke treatment with intravenous
                      thrombolysis (IVT) is restricted to a time window of 4.5 h
                      after known or presumed onset. Recently, magnetic resonance
                      imaging-guided treatment decision-making in wake-up stroke
                      (WUS) was shown to be effective. The aim of this study was
                      to determine the safety and outcome of IVT in patients with
                      a time window beyond 4.5 h selected by computed tomography
                      perfusion (CTP) imaging.We analyzed all consecutive patients
                      last seen well beyond 4.5 h after stroke onset treated with
                      IVT based on CTP between January 2015 and October 2018. CTP
                      was visually assessed to estimate the mismatch between
                      cerebral blood flow and cerebral blood volume maps. Early
                      infarct signs were documented according to Alberta Stroke
                      Program Early CT Score (ASPECTS). Safety data were obtained
                      for mortality and symptomatic intracerebral hemorrhage
                      (sICH). Follow-up was assessed with the modified Rankin
                      Scale (mRS).A total of 70 patients fulfilled the inclusion
                      criteria (mean age ± SD 77.6 ± 11.5 years, $50.0\%$
                      female). Median National Institutes of Health Stroke Scale
                      score on admission was 8.0 [interquartile range (IQR),
                      4-14]. The most frequent reasons for an extended time window
                      were WUS $(60.0\%)$ and delayed hospital admission
                      $(27.1\%).$ Median time from last seen well to IVT was
                      11.4 h. Median ASPECTS was 10 (IQR, 9-10) and CTP mismatch
                      $90\%$ (IQR, $80\%-100\%).$ A total of 24 patients
                      $(34.3\%)$ underwent additional mechanical thrombectomy.
                      sICH occurred in four patients $(5.7\%).$ At follow-up,
                      $49.3\%$ had an mRS score of 0-2 and $22.4\%$ had an mRS
                      score of 0-1.In patients presenting in an extended time
                      window beyond 4.5 h, IVT treatment with decision-making
                      based on CTP might be a safe procedure. Further evaluation
                      in clinical trials is needed.},
      keywords     = {Administration, Intravenous / Aged / Aged, 80 and over /
                      Brain Infarction: diagnostic imaging / Cerebrovascular
                      Circulation / Female / Fibrinolytic Agents: administration
                      $\&$ dosage / Fibrinolytic Agents: therapeutic use / Humans
                      / Intracranial Hemorrhages: diagnostic imaging / Magnetic
                      Resonance Imaging / Male / Middle Aged / Perfusion Imaging /
                      Stroke: diagnostic imaging / Stroke: surgery / Stroke:
                      therapy / Thrombectomy: methods / Time-to-Treatment /
                      Tomography, X-Ray Computed / Treatment Outcome},
      cin          = {AG Höglinger},
      ddc          = {610},
      cid          = {I:(DE-2719)1110002},
      pnm          = {344 - Clinical and Health Care Research (POF3-344)},
      pid          = {G:(DE-HGF)POF3-344},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31349393},
      doi          = {10.1111/ene.14051},
      url          = {https://pub.dzne.de/record/140918},
}