When do you offer TNK for ischemic stroke patients with a large vessel occlusion presenting outside the 4.5-hour window?

I agree with Dr. @Dr. First Last. Generally, I do not treat with TNK if EVT is available, but I do treat if no EVT is available, assuming favorable imaging as per the TRACE-III trial. However, as with all decisions, there are nuances. Since the benefit and risk ratio of TNK was only slightly favorab...

If you had readily available access to EVT (as did patients in TIMELESS), then there does not seem to be an added benefit of giving TNK to these patients.

Moreover, the IRIS meta-analysis showed no added benefit of alteplase before EVT in patients presenting directly to EVT centers if treatment was b...