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It integrates the “time is brain” versus “tissue clock” perspectives, evaluates how endovascular thrombectomy affects IV thrombolysis strategies, and discusses tenecteplase’s growing role. It highlights disparities in treatment access and use, while outlining faster reperfusion benefits from mobile stroke units and imaging-guided selection, including wake-up or late-presenting strokes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/intravenous-thrombolysis-for-acute-ischemic-stroke-review-article/152847/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/intravenous-thrombolysis-for-acute-ischemic-stroke-review-article/152847.png","ImageObject",300,407,{"name":92,"@type":93},"Oliver","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-08-27",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What are the key goals of IV thrombolysis in acute ischemic stroke?","Question",{"text":113,"@type":114},"IV thrombolysis aims to lyse the clot and improve outcomes when administered within appropriate time windows and selection criteria. The review emphasizes established benefits and how faster treatment increases efficacy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How do “time is brain” and “tissue clock” concepts differ, and how are they related?",{"text":118,"@type":114},"“Time is brain” focuses on urgency after symptom onset, while “tissue clock” supports treatment when brain viability remains favorable despite later presentation. The article frames them as complementary for patient selection.",{"name":120,"@type":111,"acceptedAnswer":121},"How has endovascular thrombectomy changed the role of IV thrombolysis?",{"text":122,"@type":114},"The review discusses how care systems must consider the interaction between IV thrombolysis and thrombectomy, including “drip and ship” versus direct comprehensive or endovascular thrombectomy center approaches. It also notes the possibility of skipping IV thrombolysis in selected thrombectomy patients.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},152847,1787867841,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":130,"read_time":145},8796095461610,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Intravenous Thrombolysis for Acute Ischemic Stroke  \nBy James C. Grotta, MD, FAAN  \nABSTRACT  \nOBJECTIVE: This article reviews the history of IV thrombolysis, its current indications and implementation, the duality of the “time is brain” versus“tissue clock” approaches, the impact of endovascular thrombectomy on IV thrombolysis, the emergence of tenecteplase, and future research directions.  \nLATEST DEVELOPMENTS:The growing use of factor Xa inhibitors has increasingly caused patients with stroke to be excluded from treatment with IV thrombolysis. Important geographic, socioeconomic, sex, race, and ethnic disparities have been identified in the implementation of IV thrombolysis and need to be overcome. IV thrombolysis substantially improves outcomes when provided within the first golden hour after stroke onset inpatients treated in mobile stroke units, supporting the “time is brain”concept and encouraging the possible value of more widespread implementation of the mobile stroke unit approach. At the same time, other studies have shown that IV thrombolysis can be successful inpatients whose “tissue clock” is still ticking up to 9 hours after stroke onset or in patients who awaken with their stroke, as demonstrated by favorable imaging profiles. These considerations, along with the emergence of endovascular thrombectomy, have fostered examination of our care systems, including the “drip and ship” versus direct to comprehensive or endovascular thrombectomy stroke center approaches, as well as the possibility of skipping IV thrombolysis in certain patients treated with endovascular thrombectomy. Data suggesting that tenecteplase is at least noninferior to alteplase, as well as its more convenient dosing, has led to its increased use. Ongoing studies are evaluating newer thrombolytics and adding antithrombotic therapy to IV thrombolysis.  \nESSENTIAL POINTS: IV thrombolysis remains the most common acute stroke treatment. Advances in acting faster to treat stroke have increased its efficacy, and advances in imaging have expanded its use. However, implementing these advances and overcoming disparities in IV thrombolysis use remain major challenges.  \nCONTINUUM JOURNAL . COM  \nREVIEW ARTICLE  \n􀀁  \nCONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE  \nCITE AS:  \nCONTINUUM (MIN NEA P M INN) 2023;29(2, CEREBROVASCULAR DISEASE):425–442.  \nAddress correspondence to Dr James Grotta, Memorial Hermann Hospital -Life Flight, 18th Floor Sarofim—18.300.2, 6411 Fannin St, Houston, TX 77030, james.grotta@ [memorialhermann.org](memorialhermann.org).  \nRELATIONSHIP DISCLOSURE: Dr Grotta has received personal compensation in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Haemonetics and Prolong Pharmaceuticals and in the range of $10,000 to $49,999 for serving as a consultant for Frazer Ltd and on a scientific advisory or data safety monitoring board for Acticor Biotech. The institution of Dr Grotta has received research support from Chiesi, CSL Behring, and Genentech.  \nDr Grotta has received publishing royalties from publications relating to health care.  \nUNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:  \nDr Grotta reports no disclosure.  \n© 2023 American Academy of Neurology.  \n425  \nINTRAVENOUS THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE  \nINTRODUCTION  \nT  \nhe benefits of IV thrombolysis for the treatment of acute ischemic stroke are well established. First, this article will briefly review the development and approval of recombinant tissue plasminogen activator (rtPA) followed by the exclusion criteria that have evolved since the drug’s approval. The increasing use of rtPA is described,  \nalong with the sober reality of substantial disparities in its use. This article explores the duality of the “time is brain” versus “tissue clock” concepts, which are more complementary than conflicting, and then summarizes the recent positive results with ultra-fast treatment on mobile stroke units and with imag","cbCaiqZOYTlaAX3t","https://ap.wps.com/l/cbCaiqZOYTlaAX3t","pdf",7103349,18,"English","# Introduction\n## Mechanisms and treatment scope\n# History\n## Development of rtPA and early trials\n# Indications and implementation\n## Evolving exclusion criteria and disparities\n# Time vs tissue clock\n## Golden hour and imaging-guided selection\n# Endovascular thrombectomy interaction\n## Drip-and-ship versus comprehensive thrombectomy center approaches\n# Thrombolytic agents and future directions\n## Tenecteplase and ongoing research","[{\"question\":\"What are the key goals of IV thrombolysis in acute ischemic stroke?\",\"answer\":\"IV thrombolysis aims to lyse the clot and improve outcomes when administered within appropriate time windows and selection criteria. The review emphasizes established benefits and how faster treatment increases efficacy.\"},{\"question\":\"How do “time is brain” and “tissue clock” concepts differ, and how are they related?\",\"answer\":\"“Time is brain” focuses on urgency after symptom onset, while “tissue clock” supports treatment when brain viability remains favorable despite later presentation. The article frames them as complementary for patient selection.\"},{\"question\":\"How has endovascular thrombectomy changed the role of IV thrombolysis?\",\"answer\":\"The review discusses how care systems must consider the interaction between IV thrombolysis and thrombectomy, including “drip and ship” versus direct comprehensive or endovascular thrombectomy center approaches. It also notes the possibility of skipping IV thrombolysis in selected thrombectomy patients.\"}]","Intravenous Thrombolysis for Acute Ischemic Stroke - Review Article | PDF",45]