What extended window thrombolysis protocols are your institutions implementing?

Regulatory guidelines set time epochs for IV thrombolysis at 3h (US) and 4.5h (rest of the world). Recent guidelines are similar globally, supporting a 4.5h time window. The Canadian guidelines state that: “Intravenous thrombolysis beyond 4.5 hours may be considered, in consultation with a physician...

For those with disabling deficits with last known well that is unknown and within 4.5 hours from symptom discovery or wake-up stroke with a non-intervenable LVO or no LVO, we pursue Fast Stroke MRI for IV thrombolysis assessment after CT head non-contrast and CTA head and neck. If there is an interv...

Understanding that my "institution" is the mobile stroke unit, where our current imaging capability does not include CT or MR perfusion. We treat "wake-up" strokes with TNK on the MSU if the patient can be treated within 12 hours of last known normal and 3 hours of awakening if the non-contrast CT A...