January 25, 2018/Neurosciences/Research

Benefits of Ultra-Early IV tPA Extend to Emergent Large Vessel Occlusions Too (Video)

First study of this question supports prioritizing speed in ELVO cases

For patients with emergent large vessel occlusion (ELVO), ultra-early treatment with intravenous tissue plasminogen activator (IV tPA) increases rates of recanalization and leads to improved clinical outcomes, according to a retrospective study presented at the 2018 International Stroke Conference by Cleveland Clinic researchers.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The study is the first to look at ultra-early thrombolysis — within 60 minutes of symptom onset, the “golden hour” — specifically in the setting of ELVO. It analyzed outcomes among 158 patients who received IV tPA for ELVO strokes at Cleveland Clinic and found statistically significant improvements in rates of recanalization, early neurological improvement and good neurological outcomes at 90 days among those who received IV thrombolysis within 60 minutes relative to those who received it later.

In this three-minute video, senior investigator M. Shazam Hussain, MD, explains what prompted the study and how it may reshape conventional thinking about ELVO therapy.

What we found is that those patients treated in the first hour after symptom onset as compared to those who were treated after one hour after their symptom onset, we saw much better recanalization, with 28 percent of patients in the early treatment group versus only 7 percent in the later treatment group, as well as early neurologic improvement, which was 72 percent versus only 41 percent in the later treated group…

The most important is the long-term clinical outcome, where we saw 52 percent of the patients doing very well after intravenous TPA administered in that first hour versus only 26 percent in the later treated group. This is the first study of this specific type which looked at these large blood clots… If we’re really quick in getting these patients…this drug in very, very quickly, that can actually be highly effective.

Related Articles

illustration of an alzheimer brain and a packet of sildenafil pills
March 11, 2024/Neurosciences/Research
Sildenafil as an Alzheimer’s Candidate Drug: Further Support From Insurance Database and Mechanistic Studies

Real-world claims data and tissue culture studies set the stage for randomized clinical testing

June 15, 2022/Neurosciences/Research
MINDS Study Will Assess Lifestyle Interventions for Slowing Brain Pathology in Preclinical Stages

New grant-funded investigation illustrates impact and reach of Cleveland Clinic Brain Study

March 9, 2022/Neurosciences/Research
A Closer Look at the Cleveland Clinic Brain Study

How the new longitudinal investigation could become the Framingham Heart Study of brain health

20-NEU-1959738 powered-exoskeleton-for-gait-training_650x450
October 23, 2020/Neurosciences/Research
Study Signals Potential of Powered Exoskeleton for Gait Training in Multiple Sclerosis

Pilot findings show good patient acceptance and safety, early hints of efficacy

October 21, 2020/Neurosciences/Research
Electronic Screening for Sleep Disorders Among Healthcare Workers Is Feasible – and Sorely Needed

Study finds high prevalence of symptoms, willingness to seek treatment

20-NEU-1946228 neurofilaments_650x450
September 9, 2020/Neurosciences/Research
Serum Neurofilament Light as a Progressive MS Biomarker: Guideposts for the Road Ahead

Panel outlines research priorities around a promising alternative to imaging markers

20-NEU-1951118_Impella-temporary-LVAD_650x450_ (1)
September 4, 2020/Neurosciences/Research
Study Finds Clues to Acute Neurologic Events With Short-Term Impella Cardiac Support

Suspected factors include antithrombotic intensity, time on device, presence of thrombocytopenia

20-NEU-1929179 deep-brain-stimulation-for-TBI_650x450
September 3, 2020/Neurosciences/Research
Could DBS of the Cerebellar Dentate Nucleus Enhance Post-TBI Rehabilitation?

Preclinical studies will assess whether method developed for stroke recovery curbs deficits after brain injury