Tenecteplase is a third-generation thrombolytic agent that has a favourable pharmacological profile, compared with alteplase. Tenecteplase has a longer half-life, which allows administration in a single bolus dose, a higher fibrin affinity, and higher resistance to plasminogen activator inhibitor than alteplase. As such, there has been extensive investigation into the use of tenecteplase as a promising new thrombolytic therapy for acute ischaemic stroke.1,2 Current international guidelines suggest the use of tenecteplase as an alternative to alteplase for intravenous thrombolysis in patients with acute ischaemic stroke presenting within less than 4·5 h (standard time window), on the basis of the non-inferiority shown through meta-analyses of available randomised controlled clinical trials (RCTs).