Should ASPECTS be used to determine eligiblity for thrombolysis beyond 4.5 hours?

Non-randomized studies showed this approach was not associated with increased risk of hemorrhage. The only trial -TWIST trial aimed to determine whether IV TNK given within 4.5 hours of awakening improves functional outcome in patients with ischemic wake-up stroke selected using non contrast CT head...

You can use CT and CTA (often mCTA) to decide to thrombolyse beyond 4.5h. You do not necessarily require CTP. Both cohort studies and at least two randomized trials have reported benefit from this approach. ASPECTS is a measurement scale dependent on the quality of the NCCT imaging, the quality and ...