Perfusion-guided thrombolysis beyond 4.5 hours for acute ischemic stroke: A time-stratified systematic review and meta-analysis

Wen-Wen Tsai, Kuan-Hsien Lu, Kuan-Hung Lin, Jheng-Yan Wu, Chih-Cheng Lai, Kuo Chuan Hung, Yi-Ting Tsai, Meng-Tsang Hsieh, Department of Neurology, Chi-Mei Medical Center, Department of Nutrition, Chi Mei Medical Center, Department of Public Health, College of Medicine, National Cheng Kung University, Department of Intensive Care Medicine, Chi Mei Medical Center, Department of Anesthesiology, Chi Mei Medical Center, School of Medicine, College of Medicine, National Sun Yat-sen University, Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center

Therapeutic Advances in Neurological Disorders

Published online on August 04, 2026

Abstract

Therapeutic Advances in Neurological Disorders, Volume 19, January-December 2026.
IntroductionIn the contemporary endovascular thrombectomy (EVT) era, treatment decisions are often made without routine perfusion imaging. However, perfusion remains central to intravenous thrombolysis (IVT) beyond 4.5 hours. Evidence across extended and ...