Emerging evidence in the delivery of stroke thrombolysis

Intravenous Thrombolysis (IVT) significantly increases the chance of functional independence post-stroke, and an improved understanding of delivery has ensured better safety and clinical outcomes. Despite this, there remain several aspects of IVT delivery that are yet to be clarified including: the role of new thrombolytic agents; treatment strategies for stroke with unknown onset time, including wake-up stroke; and the role of an intensive peri-thrombolysis BP target. Tenecteplase is an emerging IVT agent that has preferential characteristics yet to be fully examined in larger studies of AIS patients or sub-groups including ‘wake-up’ stroke. We await the results of on-going trials to ensure continuing optimisation of IVT delivery.