NEJM: Intravenous Thrombolysis for Acute Ischemic Stroke — New Directions

In the past 5 years, substantial changes have been made in the use of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. Integrating IVT with endovascular thrombectomy, which improves outcomes in patients with stroke due to large cerebral vessel occlusion, has been a particular challenge. This review discusses the underlying vascular targets for IVT and thrombectomy, the increasing use of tenecteplase instead of alteplase, broadening indications for the use of IVT, and ancillary drugs and dosing methods that may augment the success of IVT.