Several clinical trials have demonstrated that advanced neuroimaging can select patients for recanalization therapy in an extended time window. The favorable functional outcomes and safety profile of these studies have led to the incorporation of neuroimaging in endovascular treatment guidelines, and most recently, also extended to decision making on thrombolysis. Two randomized clinical trials have demonstrated that patients who are not amenable to endovascular thrombectomy within 4.5 hours from symptoms discovery or beyond 4.5 hours from the last-known-well time may also be safely treated with intravenous thrombolysis and have a clinical benefit above the risk of safety concerns. With the growing aging population, increased stroke incidence in the young, and the impact of evolving medical practice, healthcare and stroke systems of care need to adapt continuously to provide evidence-based care efficiently. Therefore, understanding and incorporating appropriate screening strategies is critical for the prompt recognition of potentially eligible patients for extended-window intravenous thrombolysis. Here we review the clinical trial evidence for thrombolysis for acute ischemic stroke in the extended time window and provide a review of new enrolling clinical trials that include thrombolysis intervention beyond the 4.5 hour window.

几项临床试验表明，先进的神经影像学可以在延长的时间窗口内选择患者进行再通治疗。这些研究的良好功能结果和安全性导致将神经影像学纳入血管内治疗指南，最近还扩展到溶栓决策。两项随机临床试验表明，在症状发现后 4.5 小时内或最后一次已知良好时间后 4.5 小时内不适合进行血管内血栓切除术的患者也可以安全地接受静脉溶栓治疗，并且临床获益高于安全问题。随着人口老龄化的增长、年轻人中风发病率的增加以及不断发展的医疗实践的影响，医疗保健和中风护理系统需要不断适应，以有效地提供循证护理。因此，了解和采用适当的筛查策略对于迅速识别可能符合延长窗口静脉溶栓治疗条件的患者至关重要。在这里，我们回顾了在延长时间窗内溶栓治疗急性缺血性卒中的临床试验证据，并回顾了新的纳入临床试验，其中包括超过 4.5 小时窗的溶栓干预。