The Phase III ETERNAL-LVO trial evaluated tenecteplase 0.25 mg/kg versus standard care in patients with large vessel occlusion and salvageable tissue on computed tomography perfusion presenting within 24 hours of symptom onset. Conducted across 11 stroke centers in Australia, the study was terminated early due to supply issues and emerging supportive data for tenecteplase use within 4.5 hours of symptom onset. Among 242 participants (median age: 73 years; 79% underwent endovascular therapy), no significant difference was observed in the primary outcome, modified Rankin Scale (mRS) 0-1 or return to baseline at 90 days between tenecteplase (37%) and standard care (43%; adjusted RR 0.90, 95% CI 0.66–1.21; P=0.48). Secondary analyses showed no significant differences in ordinal mRS outcomes, although a per-protocol subgroup of transfer patients treated with tenecteplase had improved odds of mRS improvement (OR 2.61, 95% CI 1.07–6.40). Symptomatic intracerebral hemorrhage occurred in 4% of tenecteplase patients vs. 1% of those who received standard care. “Treatment with tenecteplase did not increase the likelihood of a favorable functional outcome, but early stoppage of the study prevents definitive conclusions from being drawn,” the researchers report.