Abstract Background and aims Thrombolysis has transformed ischaemic stroke care. Early trials established maximal benefit within 4.5 hours, emerging evidence supports extending treatment up to 9 hours when using perfusion imaging, which is widely unavailable throughout Wales. The aims of this study were to identify the patient population eligible for extended thrombolysis window presenting to Withybush General Hospital (WGH) in 2024. Methods A retrospective cross-sectional study was conducted using data from the SNAPP database for patients presenting to WGH between 1 January and 31 December 2024. Cases presenting beyond the 4.5-hour thrombolysis window but within 9 hours or wake-up strokes were identified. Results The study included 219 patients (mean age 73.7 ± 13.1 years; 39.7% female). Median onset-to-presentation time was 518.5 min (IQR 136.5–1180). 30 (13.7%) presented within the 9-hour thrombolysis window, 25 (11.4%) presented with wake-up stroke. Thrombolysed patients had significantly lower discharge mRS scores (2.3 (SD +/-1.9); vs non-thombolysed 3.44 (SD +/- 1.89); t(56) -2.40; p=0.001), and shorter hospital stays (16.3 (SD +/- 27.3); vs non-thrombolysed mean 29.6 (SD +/-33.9); t(47) -1.72; p=0.046). Conclusions Thrombolysis improves patients' degree of disability post stroke. Our cohort demonstrates most patients do not present to hospital within 4.5 hours of symptom onset. More evidence is emerging to suggest an extended thrombolysis window is effective in combination with clinician judgement and brain perfusion imaging. If implemented across Wales this could significantly increase the number of patients with positive outcomes. Conflict of interest Chloe Thomas: nothing to disclose, Caradog Hanna-Davies: nothing to disclose
Thomas et al. (2026) studied this question.