In patients presenting with acute ischemic stroke who are treated within 4.5 to 24 hours of symptom onset, tenecteplase (TNK) significantly enhances the likelihood of achieving excellent functional outcomes and successful recanalization, while crucially avoiding an increase in the risks of symptomatic intracerebral hemorrhage or mortality, according to new research. The meta-analysis of four randomized controlled trials included a total of 1,278 patients. At 90 days, TNK demonstrated a significant increase in excellent functional outcomes and a substantially higher rate of recanalization compared with the control group. However, there were no significant differences between the TNK and control groups regarding good functional outcomes (defined as a modified Rankin Scale score of 0–2), overall reperfusion rates, or early neurological improvement. Subgroup analyses revealed that in non-endovascular thrombectomy (EVT) settings, TNK enhanced good functional outcomes, early neurological improvement, and markedly higher recanalization rates. By contrast, in EVT-permitted settings, TNK’s benefit was limited to improved recanalization. The researchers note that “extended-window TNK provides greater additional benefits when EVT is inaccessible, establishing its role as an alternative reperfusion strategy in resource-limited settings.”