Ayush Agarwal, MD, DM, DNB
The management of acute ischemic stroke continues to progress, and there is a shift towards ‘tissue window’ from the traditional ‘time window.’ Recent trials have demonstrated that thrombolysis can safely be done out of the traditional time window based on careful patient selection using advanced imaging techniques including brain MRI and CT-perfusion (1,2). Although, traditionally, alteplase has been the mainstay of treatment, tenecteplase usage is rapidly gaining ground based on ease of administration and higher fibrin specificity. It has not only been proven non-inferior, but also better at lysing large vessel clots (when compared to alteplase) (3). The advent of mobile stroke units with CT scanners and point-of-care laboratory support has further reduced door-to-needle times and led to even better stroke outcomes (4,5).