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A healthy 60-year-old man presents with acute left-sided weakness 4 hours after symptom onset. National Institutes of Health Stroke Scale score is 8. Head computed tomography shows no hemorrhage or early signs of ischemia. Routine laboratory tests are within normal.1. Should he be treated with intravenous thrombolysis?2. Are other tests needed before initiation of treatment?Is the 4.5-hour time window for intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-Pa) firmly established?This is a clear case. Yes! The patient should immediately be treated with the standard dose of rt-PA as per approval in Europe and many other countries on this planet. After the results of all pooled analyses (National Institute of Neurological Disorders and Stroke [NINDS], European Cooperative Acute Stroke Study 1–2 [ECASS 1–2], Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke [ATLANTIS]), Cochrane Analyses, Safe Implementation of Treatment in Stroke International Stroke Thrombolysis Register (SITS-ISTR), and others,1 the effect size with an odds ratio for a favorable (modified Rankin Scale, 0–1) versus unfavorable outcome was established at …

4.5-Hour Time Window for Intravenous Thrombolysis With Recombinant Tissue-Type Plasminogen Activator Is Established Firmly