Findings from the EXPECTS randomized clinical trial make a case for extending the therapeutic window for I.V. thrombolysis following posterior circulation stroke. The approach is known to be effective at least 4.5 hours after symptom onset and up to 9 hours later, but its performance beyond that is unclear. EXPECTS investigators enrolled adults from 30 stroke centers in China, disqualifying any who had endovascular thrombectomy already planned. The sample population included 234 participants, one-half of whom received alteplase within 24 hours and one-half who received usual care within the same time frame. Functional independence at 90 days — the primary efficacy endpoint — was achieved by 89.6% of patients in the alteplase treatment arm compared with 72.6% in the control group. Key safety outcomes included symptomatic intracranial hemorrhage within 6 hours, measured at 1.7% in the intervention group vs. 0.9% in the standard treatment group, and death, occurring respectively in 5.2% and 8.5% of participants. Based on their results, the study authors endorse the use of I.V. alteplase, when endovascular treatment is not available, up to 24 hours after onset of posterior circulation stroke.