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.

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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.

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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.