Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
Review article. Revista multidisciplinaria investigación Contemporánea.
Vol. 3 - No. 1, pp. 72- 96. January-June, 2025. e-ISSN: 2960-8015
Indications and risks of the treatment
brinolytic in accident patients
Ischemic cerebrovascular
Indicaciones y riesgos sobre el tratamiento brinolítico
en pacientes con accidente cerebrovascular isquémico
1 Universidad Católica de Cuenca Sede Azogues; pesantezcoronel99@outlook.com. Azogues, Ecuador.
2 Universidad Católica de Cuenca Sede Azogues; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.
3 Universidad Católica de Cuenca Sede Azogues; eric.abad.77@est.ucacue.edu.ec. Azogues, Ecuador.
4 Universidad Católica de Cuenca Sede Azogues; sergio.narvaez@est.ucacue.edu.ec. Azogues, Ecuador.
5 Universidad Católica de Cuenca Sede Azogues; camila.cuesta@est.ucacue.edu.ec. Azogues, Ecuador.
Pesántez Coronel AE 1, Faicán Rocano PF 2, Abad Baculima ES 3,
Narváez Chacón SX 4, Cuesta Buestan CV 5
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a87
How to cite:
Pesántez Coronel, A., Faican Rocano, P., Abad Baculima , E., Narváez Chacón , S., & Cuesta Buestan , C. (2024).
Indications and risks on brinolytic therapy in patients with ischemic stroke. Multidisciplinary Journal Contem-
porary Research, 3(1). https://doi.org/10.58995/redlic.rmic.v3.n1.a87.
Article information:
Received: 25-04-2024
Accepted: 04-10-2024
Published: 17-01-2025
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Sources of nancing:
The research was carried out with own resources.
Conicts of interest:
No conicts of interest.
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Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a87
Indications and risks of the treatment brinolytic in accident patients
Ischemic cerebrovascular 73 - 96
Abstract
Introduction: Stroke causes functional limitation, worsening status, frailty and
demand for health care; Objective: To assess the quality of scientic evidence from
a systematic review focused on the efcacy of stroke treatment. Objective: To assess
the quality of scientic evidence from a systematic review focused on the efcacy
of brinolytic brinolytic treatment in patients with ischemic stroke; Methodology:
Systematic review of meta-analyses published between 2018 - 2023, in English and
Spanish; Results: Fibrinolysis is fundamental in the reduction of disability secondary
to the event. The use of tenecteplase leads to complete recanalization (38.5%); while
alteplase 29%. A hemorrhagic risk of 3.05% for tenecteplase and 2.86% in alteplase,
statistically alteplase, statistically signicant (RR: 1.27 with 95% CI [1.02 - 1.57], p
= 0.03). Therefore, tenecteplase is an effective option for treatment considering its
minimal likelihood of producing bleeding; Conclusions: Both drugs are effective
and adequate. However, tenecteplase ensures a lower risk of bleeding.
Keywords: stroke, brinolysis, cerebral ischemia, treatment.
Resumen
Introducción: Un accidente cerebrovascular produce una limitación funcional,
empeorando el estado, fragilidad y demanda de atención en la salud; Objetivo: Valorar
la calidad de evidencia cientíca a partir de una revisión sistemática enfocada en
la ecacia del tratamiento brinolítico en pacientes con accidente cerebrovascular
isquémico; Metodología: Revisión sistemática de metaanálisis publicados entre 2018
– 2023, en idioma inglés y español; Resultados: La brinólisis, es fundamental en la
reducción de discapacidad secundaria al evento. El uso de tenecteplasa conduce a
una recanalización completa (38,5%); mientras que la alteplasa un 29%. Un riesgo
hemorrágico de 3,05% para tenecteplasa y 2,86% en alteplasa, estadísticamente
signicativos (RR: 1,27 con IC 95% [1,02 - 1,57], p = 0,03). Por lo tanto, la tenecteplasa
es una opción ecaz para el tratamiento considerando su mínima probabilidad
de producir una hemorragia; Conclusiones: Los dos medicamentos son ecaces y
adecuados. Sin embargo, la tenecteplasa asegura un menor riesgo de hemorragia.
Palabras clave: accidente cerebrovascular, brinólisis, infarto cerebral, tratamiento.
Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a87
Indications and risks of the treatment brinolytic in accident patients
Ischemic cerebrovascular 74 - 96
1. Introduction
Stroke (ACV) is dened as a functional alteration of the brain, whether transient
or permanent, whose main cause is vascular in origin, affecting one or more
parts of the brain. According to the World Health Organization (WHO), there
are 15 million people with stroke every year worldwide, most of whom die or are
left with permanent sequelae, radically affecting their environment (1-4).
It is currently one of the main causes of morbidity and mortality worldwide,
and is therefore considered the main reason for consultation in emergency
neurological care (12). It is a “time- dependent” pathology, in which 87% of cases
are of ischemic origin, of which 80% have an atherosclerotic origin (1,2).
An ischemic stroke is triggered in people with vascular narrowing, and
older adults are the ones who develop vascular sclerosis due to the patient's
age. A hemorrhagic stroke results from the rupture of a blood vessel, associated
with risk factors such as the presence of aneurysms, hypertension, use of
anticoagulants and patients with amyloid angiopathy (5,6).
Based on this premise, it is necessary to mention the determining risk
factors when it comes to producing a cerebrovascular event in a person, which
can be modiable or non-modiable.
Within the group of modiable factors are arterial hypertension, sedentary
lifestyle, overweight, malnutrition and the consumption of substances such as
tobacco, increasing the probability of developing a stroke by 2.5% - 4.1% in men
and 3.6% - 5.8% in women (7,13). Among the non-modiable factors, the age of
each patient is mentioned, being the most important since a higher risk is seen
in adults who are between 65 - 80 years old; where women maintain a certain
protective factor due to the production of estrogens until before menopause
(1,7,13).
According to the “National Institute of Neurological Disorders and Stroke”
(NINDS), an ischemic stroke, also known as STROKE, is a sudden and emergent
episode requiring immediate action due to the proportional relationship of
injury, “time is brain,” since irreversible neurological damage will not necessarily
be observed in the rst few minutes of clinical deciency, so effective treatment
Revista multidisciplinaria
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a87
Indications and risks of the treatment brinolytic in accident patients
Ischemic cerebrovascular 75 - 96
will preserve the affected brain cells and reduce brain damage by up to 80%,
and in some cases even reverse it (9,10).
2. Methodology
2.1. Study design
2.1.1. Eligibility criteria
For the development of this criterion, a research question was posed: What is
the current level of scientic evidence related to brinolytic treatment applied
in patients suffering from ischemic stroke? Therefore, specic points were
established to take into account when selecting each publication.
Studies included:
a) They were published in databases such as PubMed, Scopus, Redalyc
and ScienceDirect, within the period 2018 – 2023.
b) Publications written in English and Spanish.
c) Studies that belong to medical societies and provide a scientic
approach related to the objective of the work.
d) Meta-analysis and systematic reviews, based on the Oxford scale,
considering the into account ranges 1a – 2b.
Studies were excluded:
a) They do not explain the methodological process of precision.
b) They present a discussion with incongruent information.
c) They mention some type of conict of interest.
d) They focus on a population under 40 years of age.
2.2. Data extraction
2.2.1. Information sources
Based on the PRISMA 2020 model, an appropriate and correct methodological
process was carried out for the selection of publications in order to exemplify
and quantify these studies.
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2.2.2. Search strategies
By using Boolean operators, known as AND, OR, NOT, the information search
process was facilitated, ensuring that the collection of data and information is
up-to-date, relevant, and related to the topic of study.
2.2.3. Summary of results
The identication of the selected studies began with a general search of the
topic, obtaining 353 general works, of which 68 belonged to Scopus, 186 to
PubMed, 18 to ScienceDirect and 81 to Redalyc. Through the evaluation of
bibliographic records and various criteria, a total of 341 works was excluded.
Finally, the inclusion criteria were considered, reaching a selection of 15 studies
that met each established point, were approved and evaluated to be used in the
bibliographic review (Figure 1).
Subsequently, a second analysis was carried out, in which a detailed reading
of the segments of each study was carried out: methodology, development,
discussion, conclusions and recommendations. To avoid duplicate documents
and to have a better organization, the Zotero tool was used, a platform that
allows storing the studies, nding them more quickly and having the most
relevant information.
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2.2.4. Methodological quality
To ensure the adequate quality of information in the study, the Oxford Quality
Scale was used, a tool that allows for standardizing information, ranking each
study, identifying any type of bias present and assessing the limitations found.
The scale has 5 levels that consider the type of study, the clinical problem in
question and its thematic area in order to classify it and give it an adequate
value.
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Level 1: High Quality Evidence
• 1a: Meta-analysis of well-designed randomized controlled trials (RCTs).
• 1b: At least one well- designed RCT.
• 1c: “All-or-nothing” therapies (when all patients die without treatment
and some survive with treatment).
Level 2: Moderate Quality Evidence
• 2a: Systematic review of high-quality cohort studies.
• 2b: Cohort study (including follow-up studies of RCTs).
• 2c: Results of outcome-based research (e.g., case studies) database).
Level 3: Limited Quality Evidence
• 3a: Systematic review of case-control studies.
• 3b: Case-control study.
Level 4: Low Quality Evidence
• 4: Case series (and low-quality cohort and case-control studies).
Level 5: Expert Opinion
• 5: Expert opinion without explicit critical evaluation, or based on
physiology, laboratory research or theoretical principles.
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3. Development
Bibliometric studies
Table númber 1. Compilation of studies according to their year of publication.
BASE OF
DATA
YEARS
2016 2019 2020 2021 2022 2023 2024 TOTAL
F % F % F % F % F % F % F % F %
Scopus 1 6,7 0 0 1 6,7 0 0 0 0 1 6,7 0 0 3 20
Pubmed 0 0 0 0 0 0 0 0 3 20 1 6,7 2 13,3 6 40
Redalyc 0 0 1 6,7 0 0 1 6,7 1 6,7 0 0 0 0 3 20
Sciencedirect 0 0 0 0 0 0 0 0 0 0 1 6,7 2 13,3 3 20
TOTAL 1 6,7 1 6,7 1 6,7 1 6,7 4 26,7 3 20 4 26,7 15 100
Note. Source: authors
Figure 1. Database Studies of the Systematic Review, after selection lter by
years. Source: Authors
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The articles used for this study were obtained from the scientic databases
PubMed, Scopus, Redalyc and ScienceDirect. Most were published in 2022,
followed by some from 2024, and one study from 2016 was included because its
results were statistically signicant when using a wider therapeutic window.
The chosen research articles were obtained through a systematic review in
the following scientic databases: ScienceDirect (3 articles, 20%), PubMed (6
articles, 40%), Scopus (3 articles, 20%) and Redalyc (3 articles, 20%).
Data collection:
After completing the systematic research ow, specic tables are prepared in
accordance with the PRISMA 2020 guide.
Table 2: Data collection on brinolytic therapy.
N.º ISSUE BASE OF
DATA
YEARS
PUBLISH AUTHORS STUDY DRUG LINK
1
Safety and efcacy
of tenecteplase
versus
alteplase in
patients with
acute ischemic
stroke
(TRACE): A
multicenter,
randomized, open-
label, blinded,
controlled phase II
study
(PROBE)
Pubmed 2022
Li S, Pan Y,
Wang Z, et
al. (28)
Clinical trial:
multicenter,
prospective,
randomized,
open, blinded
and phase II
tenecteplasa
TNK
alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/34429364/
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2
The efcacy
and safety of
tenecteplase
versus
alteplase for acute
ischemic stroke:
an
updated
systematic review,
pairwise, and
network meta-
analysis of
randomized
controlled trials.
Pubmed 2023 Abuelazm
M, et al. (30)
Metaanálisis
ECA
tenecteplasa
TNK
alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/36449231/
3Alteplasa
intravenosa Pubmed 2020 Thomalla G,
et al. (29)
Metaanálisis
ECA: WAKE-
UP, EXTEND,
THAWS y
ECASS-4.
PLACEBO
alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/33176180/
4
Intravenous
brinolysis of
ischemic stroke
in a medium
complexity
municipal
hospital in the
city of General
Villegas, province
of Buenos Aires.
Sciencedirect 20016 Hawkes MA,
et al. (36)
Retrospective
studies
alteplasa
t-PA
http://www. scielo.
org.ar
/scielo.php?
script=sci_a
rttext&pid=
S0025-
5
Intravenous
thrombolysis in
acute ischemic
stroke patients
with pre- stroke
disability: A
systematic review
and meta-analysis.
Pubmed 2023 Bao Q, et al.
(37) Metaanálisis alteplasa
rt-PA
https://on linelibrar
y.wiley.c om/doi/1
0.1002/b
rb3.3431
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6
Tenecteplase
versus alteplase
for patients with
acute ischemic
stroke: a meta-
analysis of
randomized
controlled trials.
Pubmed 2023 Zhang X, et
al. (32)
Metaanálisis
ECA
tenecteplasa
TNK
alteplasa
rt-PA
https://www
.ncbi.nlm.ni h.gov/
pmc/a rticles/PMC
10781500/
7
Comparative
efcacy and safety
of tenecteplase
and alteplase in
acute ischemic
stroke: a pairwise
and network
meta-analysis
of randomized
controlled trials
Pubmed 2022 Rehman AU,
et al. (33)
Metaanálisis
ECA
tenecteplasa
TNK
alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/36630803/
8
Tenecteplase
versus alteplase
for intravenous
thrombolytic
treatment of acute
ischemic stroke: a
systematic review
and meta-analysis.
Pubmed 2023 Shen Z, et al.
(34)
Metaanálisis
tenecteplasa
TNK
alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/37552459/
9
Efcacy of
tenecteplase
compared with
alteplase for
treatment of acute
ischemic stroke. A
narrative review
Redalyc 2023 Cedillo-
Reyes N, et
al. (42)
Metaanálisis
ECA
alteplasa
rt-PA
tenecteplasa
TNK
https://www.scielo.cl/
scielo.php?script=sci_
arttext&pid=S0717-
92272023000300363
&lng=en&nrm=iso&tl
ng=en
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10
Efcacy and
safety outcomes
of Tenecteplase
versus Alteplase
for thrombolysis
of acute ischemic
stroke: a meta-
analysis of 9
randomized
controlled trials.
Sciencedirect 2024 Wang Y, et
al. (35)
Metaanálisis
ECA
tenecteplasa
TNK
alteplasa
rt-PA
https://www.sci
encedirect.com/
science/article/
abs/pii/S00225
10X24000479
11
Pharmacological
Fibrinolysis in
Acute Ischemic
Stroke: Experience
in a Tertiary
Hospital in
Ecuador.
Redalyc 2019
Scherle
Matamoros
C, et al. (38)
Prospectivo,
longitudinal
ECA
alteplasa
rt-PA
http://sci elo.senes
cyt.gob.e c/scielo.p
hp?script
=sci_artt
12
Uso y
resultados de la
brinololisisis
intravenosa
en una unidad
cerebrovascular
/ Use and results
of intravenous
brinolysis in a
stroke
Pubmed 2021
Rosales
Julieta S, et
al. (39)
Retrospectivo
observacional
ECA
alteplasa
rt-PA
http://www. scielo.
org.ar
/scielo.php?
script=sci_a
rttext&pid=
S0025-
13
Results of bridging
intravenous
thrombolysis
versus
endovascular
therapy alone in
acute late window
ischemic stroke.
Pubmed 2024 Demeestere
J, et al. (40)
Retrospectivo
Multicéntrico
alteplasa
rt-PA
https://ww
w.ahajourn als.org/
doi
/10.1161/S
TROKEA HA.124.04
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14
Predictors of poor
outcome in acute
ischemic stroke
patients treated
withalteplase,
a multicenter
randomized trial
Sciencedirect 2024
Zeinhom
MG, et al.
(41)
ECA alteplasa
rt-PA
https://pubmed.
ncbi.nlm.nih.go
v/38472241/
15
Benets of
thrombolysis with
rtPA in patients
with ischemic
cerebrovascular
event, according to
age group.
Sciencedirect 2024
Cedeño
Almeida LY,
et al. (42)
Metaanálisis alteplasa
rt-PA
https://doi.
or g/10.1038/s
41598-024-
56067-5
Source: Review sheets
Author: Andrés Esteban Pesantez Coronel
Indications on the application of brinolytic treatment in patients with
ischemic stroke.
The systematic review analysed 15 studies that showed similarities in the
therapeutic regimens used for the treatment of ischaemic stroke internationally.
The dose of alteplase was 0.9 mg/kg, while that of tenecteplase varied between
0.1, 0.25 and 0.32 mg/kg, administered within a therapeutic window of less than
4.5 hours in all the studies reviewed.
Efcacy of different drugs used in brinolytic treatment in patients with
ischemic CVD.
Eight studies comparing the efcacy of the different drugs used were compiled,
7 of these studies compared tenecteplase and alteplase, while one study
compared alteplase with placebo. The results indicate recanalization rates
ranging from 28% to 54% for tenecteplase. For alteplase, the results range from
24% to 47%. It is observed that in the study comparing alteplase with placebo, a
recanalization rate of 39% is presented in favor of placebo.
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Likewise, the early neurological improvement presented by patients is
stated, which has results ranging from 23% to 56% for tenecteplase.
Comparing it with alteplase we have gures that range between 26% and
56%. In the placebo study it gives us a value of 29% (25,26,27,29,30,31,32,39).
Risks of applying brinolytic treatment in patients with ischemic stroke
The administration of alteplase and tenecteplase in stroke carries risks such
as intracerebral hemorrhage, serious adverse events and death. According
to 8 studies (Table 5), tenecteplase was associated with arrhythmias (3-5%),
hypotension (12-20%), severe hypersensitivity (2-12.3%), mortality (3-10%)
and hemorrhage (2-5%). Alteplase was associated with arrhythmias (1.7-6.7%),
hypotension (1-13%), severe hypersensitivity (1-18%), mortality (1.2-10.2%) and
hemorrhage (1.7-3.7%) (25,29,30,31,34,36,37,38).
Indications on the application of brinolytic treatment in patients with
ischemic stroke
Alteplase was approved in 1996 by the Food and Drug Administration to treat
acute ischemic stroke following the National Institute of Neurological Disorders
and Stroke (NINDS) study, which demonstrated that rtPA administered during
the rst 3 hours resulted in complete recovery in patients (1,2,3,4,16,18).
In the European Cooperative Acute Stroke Study (ECASS I, II, and III),
the extension of the treatment window in patients with ischemic stroke was
evaluated. The results showed that those treated with rt-PA within four hours of
the event were more likely to achieve favorable functional recovery, according
to the mRS 01 scale, at 90 days of follow-up (1,2,3,4,25,26).
The study “Extending the Time for Thrombolysis in Emergency
Neurological Decits” (EXTEND) demonstrated that treatment with alteplase
for 4.5 to 9 hours, in patients with salvageable brain tissue, resulted in a greater
likelihood of functional independence at 90 days, according to the mRS 01 scale.
However, the group receiving rt-PA showed a non- signicant increase in cases
of symptomatic cerebral hemorrhage (1,2,3,4,25,26).
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A 2014 meta-analysis evaluated 6756 patients with ischemic stroke randomized
to receive rt- PA or placebo in several studies. The primary endpoint was the
mRS 0-1 score at 90 days. The results showed that alteplase administration
within the rst 3 hours was associated with a better outcome (33%) compared
with the control group (23%) (OR 1.75, 95% CI 1.35-2.27).
By extending the therapeutic window to 3-4.5 hours, the percentage of
positive results was 35% with rt-PA vs 30% in the control group (OR 1.26, 95%
CI 1.05-1.51). Neither age nor severity of the event had a signicant inuence.
However, treatment with rt-PA increased the risk of intracranial hemorrhage to
6.8% vs 1.3% in the control group (OR 5.55, 95% CI4.01-7.70) (1,2,3,4,25,26).
The Tenecteplase vs Alteplase Safety and Efcacy in Patients with Acute
Ischemic Stroke (TRACE) study found that use of alteplase TNK resulted
in better outcomes. Recanalization was achieved in 28% of patients treated
with a dose of 0.32 mg/kg (OR 1.16 [95% CI 1.14-2.13]; p=0.014), with excellent
neurological recovery (RR 1.14; 95% CI 1.06-1.12; p=0.03). However, use of low-
dose tenecteplase (0.1 mg/kg) was associated with a 12% rate of disability as an
adverse event (27).
Although international protocols state that the therapeutic window
for treating ischemic stroke should not exceed 4.5 hours for administering
brinolytics, in practice, the time of onset of the disorder is often unknown.
One study demonstrated that intravenous alteplase offers better functional
outcomes at 90 days compared with placebo or standard care, with high
recanalization rates in TNK (OR 1.49 [95% CI 1.10-2.03]; p=0.011) and excellent
neurological recovery (OR 1.50; 95% CI 1.06-2.12; p=0.022). Although a net
benet in functional outcomes was observed, an increased risk of symptomatic
intracranial hemorrhage was also reported. Tenecteplase (TNK) shares
administration criteria with alteplase and is in phase III clinical trials, showing
similar results.
The study conducted by Julieta Rosales indicated that the use of TNK
reduced the hospitalization time from 9 to 5 days (p < 0.00001) and shortened
the door-to-needle time from 75 minutes with alteplase to 53 minutes with
TNK (p < 0.00001), in addition to 76% of patients receiving treatment within 60
minutes in the TNK group versus 36% in the alteplase group (p < 0.00001) (28).
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Efcacy of different drugs used in brinolytic treatment in patients with
ischemic stroke
People who have suffered an ischemic stroke with unknown onset time have
been excluded from thrombolysis. However, intravenous alteplase has been
shown to be safe and effective in these cases, provided salvageable tissue is
identied by biomarker imaging. In addition, improved functional outcome has
been observed at 90 days compared to placebo or standard care. There is a net
benet in all functional outcomes, despite the increased risk of symptomatic
intracerebral hemorrhage. It is also mentioned that the door-to-needle time
is reduced regardless of the therapeutic window, which increases the delay in
prehospital time (38).
Comparison of the efcacy and safety of tenecteplase and alteplase in
ischemic stroke is ongoing. Preliminary results indicate that TNK is signicantly
associated with complete recanalization (RR: 1.27 with 95% CI [1.02, 1.57], P =
0.03). However, no differences were found in early neurological improvement
(RR: 1.07 with 95% CI [0.94, 1.21], P = 0.33) or excellent neurological recovery
(RR: 1.03 with 95% CI [0.96, 1.10], P = 0.42 (27).
Risks of applying brinolytic treatment in patients with ischemic stroke
Tenecteplase (TNK) is a newer brinolytic agent with greater specicity for brin
and a longer half- life than alteplase. Both TNK and rt-PA are associated with
adverse events, including prolonged hospitalization, disability, dysfunction,
intracerebral hemorrhage, and mortality.
The Safety and Efcacy Study of TNK versus Alteplase in Patients with
Acute Ischemic Stroke (TRACE) showed that adverse events were more frequent
with low doses of TNK, reporting 12.3% disability and 5% serious adverse events.
In terms of morbidity, the risk was similar between TNK and rt-PA at doses of
0.1 mg/kg and 0.9 mg/kg, respectively (27).
4. Conclusions
The use of TNK (Tenecteplase) compared to rtPA (Alteplase) in the treatment
of ischemic stroke presents notable differences in the time of administration,
where TNK is applied in a single dose of 0.32 mg/kg as a bolus, being equally
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safe and effective as alteplase, which is administered as a bolus and over one
hour at a dose of 0.9 mg/kg.
TNK does not increase intracerebral hemorrhage relative to alteplase;
however, procedure-related mortality is identied in 15 studies as a risk that
must be mitigated. Therefore, tenecteplase can be administered in the absence
of alteplase, without the risk of causing intracranial hemorrhage or patient
death. Door-to-needle time is reduced to 53 minutes, and the treatment window
is extended to 4.5 hours, resulting in fewer complications for patients with
difculties in the initial evaluation.
The prognosis of ischemic stroke is determined by its severity, which
establishes the functional prognosis, the risk of disability and the response to
brinolytic treatment that facilitates cerebral recanalization and reperfusion
in the patient.
Therefore, the evaluation of neurological decit is crucial, using scales
such as the NIHSS (National Institutes of Health Stroke Scale) that predict the
efcacy of treatment in terms of sensitivity and specicity.
5. Authors' contribution
PC rst author: basic structure of the research, analysis of the information.
FR third author: review, correction and conguration of the article
AB fourth author: review and restructuring to article format.
NC fth author: review and restructuring to article format.
CB sixth author: review and restructuring to article format.
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