TITLE:
Reperfusion Decision-Making and In-Hospital Workflow Performance in Wake-Up, Unknown-Onset, and Known Beyond-Window Acute Ischemic Stroke: A Three-Year Single-Center Real-World Retrospective Study
AUTHORS:
Yaojie Cai, Feng Fu, Yan Chen, Yuping He
KEYWORDS:
Wake-Up Stroke, Unknown-Onset Stroke, Known Beyond-Window Stroke, Acute Ischemic Stroke, Intravenous Thrombolysis, Reperfusion Therapy, Door-to-Needle Time, Workflow Performance, Firth Regression, Real-World Study
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.10,
October
13,
2026
ABSTRACT: Objective: To characterize reperfusion decision-making, in-hospital workflow efficiency, and the principal reasons for withholding intravenous thrombolysis in an extended-window acute ischemic stroke (AIS) pathway including wake-up stroke, unknown-onset stroke, and known beyond-window presentations. Methods: We retrospectively screened 349 consecutive emergency stroke-pathway records from January 2023 to December 2025. Four records with a final diagnosis other than AIS were excluded, leaving 345 AIS cases. The historical binary 4.5-h field was treated as a registry-recorded operational variable because a uniform last-known-well or symptom-discovery anchor could not be verified across years. Missing covariates were not randomly imputed for the final analysis. Because of the limited number of thrombolysis events, multivariable associations were assessed using Firth penalized logistic regression with profile-likelihood 95% confidence intervals (CIs). Results: Twenty-seven of 345 patients (7.8%) received intravenous thrombolysis: 26/186 (14.0%) with wake-up stroke, 0/3 (0%) with unknown onset, and 1/156 (0.6%) with known beyond-window presentation. Median age was 71 (61, 80) years and 217 (62.9%) were men. Baseline NIHSS was available in 201 patients and was 4 (2, 7) overall; treated patients had higher scores than untreated patients [8 (5, 14) vs. 3 (1, 6), P