Real-world implementation and outcomes of extended-window intravenous thrombolysis in Catalonia, 2016-2024: A population-based study using the CICAT registry.
Abstract
Background. Evidence supporting intravenous thrombolysis (IVT) beyond 4.5 hours is based on selected populations using advanced imaging, while real-world data remains limited. We describe its uptake, selection strategies, treatment pathways, and outcomes in routine practice. Methods. We conducted a population-based observational study using the prospective multicenter CICAT registry in Catalonia, Spain (2016-2024). Patients receiving extended-window IVT (>4.5 hours or unknown onset) were grouped into IVT alone and IVT before mechanical thrombectomy (bridging therapy), with conventional-window patients as a clinical reference. Excellent functional outcome was defined as a 90-day modified Rankin Scale (mRS) 0–1 or return to prestroke mRS, and good functional outcome as mRS 0–2 or return to prestroke mRS. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Results. Among 12,547 patients treated with IVT, 656 (5.2%) received extended-window treatment (450 IVT alone; 206 bridging therapy). The proportion treated in the extended window increased from 3.5% in 2016-2018 to 7.4% in 2022-2024, with perfusion imaging predominantly guiding patient selection (84.1%). In the IVT alone cohort, excellent functional outcome occurred in 42.8% of extended-window and 47.2% of conventional-window patients; sICH occurred in 3.6% and 2.3%, and mortality in 12.9% and 12.5%, respectively. Corresponding outcomes in the bridging cohort 40.0% and 45.1% for good functional outcome, 20.6% and 18.6% for mortality, and 5.8% and 4.1% for sICH respectively. Differences with the reference group were also generally modest among patients aged >80 years and those with prestroke disability. Conclusions. Extended-window IVT was progressively adopted across a population-based stroke network, predominantly using advanced imaging. Among selected patients, observed differences in functional and safety outcomes relative to the conventional-window reference group were generally modest, including in populations underrepresented in randomized trials. These findings should be interpreted in the context of differences in patient selection and case mix between treatment windows.
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BibTeX
@misc{vallevargas2026realworld,
title = {{Real-world implementation and outcomes of extended-window intravenous thrombolysis in Catalonia, 2016-2024: A population-based study using the CICAT registry.}},
author = {C. del Valle-Vargas and M. Martinez-Sanchez and I. Vielba-Gomez and Y. Silva and A. Doncel-Moriano and A. Rodriguez Vazquez and B. Lara-Rodriguez and A. Nunez Guillen and A. Garcia-Tornel and F. Purroy and D. Caraballo and G. Figueras-Aguirre and P. Esteve and G. Ezcurra-Diaz and A. Rodriguez-Campello and D. Cocho and C. Larranaga and D. Santana Moreno and B. Yugueros and X. Jimenez-Fabrega and M. Salvat-Plana and M. Millan and N. Perez de la Ossa},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26366275},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366275v1},
note = {Public domain},
}
RIS
TY - UNPB
TI - Real-world implementation and outcomes of extended-window intravenous thrombolysis in Catalonia, 2016-2024: A population-based study using the CICAT registry.
AU - C. del Valle-Vargas
AU - M. Martinez-Sanchez
AU - I. Vielba-Gomez
AU - Y. Silva
AU - A. Doncel-Moriano
AU - A. Rodriguez Vazquez
AU - B. Lara-Rodriguez
AU - A. Nunez Guillen
AU - A. Garcia-Tornel
AU - F. Purroy
AU - D. Caraballo
AU - G. Figueras-Aguirre
AU - P. Esteve
AU - G. Ezcurra-Diaz
AU - A. Rodriguez-Campello
AU - D. Cocho
AU - C. Larranaga
AU - D. Santana Moreno
AU - B. Yugueros
AU - X. Jimenez-Fabrega
AU - M. Salvat-Plana
AU - M. Millan
AU - N. Perez de la Ossa
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26366275
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26366275v1
AB - Background. Evidence supporting intravenous thrombolysis (IVT) beyond 4.5 hours is based on selected populations using advanced imaging, while real-world data remains limited. We describe its uptake, selection strategies, treatment pathways, and outcomes in routine practice. Methods. We conducted a population-based observational study using the prospective multicenter CICAT registry in Catalonia, Spain (2016-2024). Patients receiving extended-window IVT (>4.5 hours or unknown onset) were grouped into IVT alone and IVT before mechanical thrombectomy (bridging therapy), with conventional-window patients as a clinical reference. Excellent functional outcome was defined as a 90-day modified Rankin Scale (mRS) 0–1 or return to prestroke mRS, and good functional outcome as mRS 0–2 or return to prestroke mRS. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Results. Among 12,547 patients treated with IVT, 656 (5.2%) received extended-window treatment (450 IVT alone; 206 bridging therapy). The proportion treated in the extended window increased from 3.5% in 2016-2018 to 7.4% in 2022-2024, with perfusion imaging predominantly guiding patient selection (84.1%). In the IVT alone cohort, excellent functional outcome occurred in 42.8% of extended-window and 47.2% of conventional-window patients; sICH occurred in 3.6% and 2.3%, and mortality in 12.9% and 12.5%, respectively. Corresponding outcomes in the bridging cohort 40.0% and 45.1% for good functional outcome, 20.6% and 18.6% for mortality, and 5.8% and 4.1% for sICH respectively. Differences with the reference group were also generally modest among patients aged >80 years and those with prestroke disability. Conclusions. Extended-window IVT was progressively adopted across a population-based stroke network, predominantly using advanced imaging. Among selected patients, observed differences in functional and safety outcomes relative to the conventional-window reference group were generally modest, including in populations underrepresented in randomized trials. These findings should be interpreted in the context of differences in patient selection and case mix between treatment windows.
ER -