What are the potential benefits of administering IV alteplase to patients with AIS who have an unclear time of onset and a DW-MRI lesion smaller than one-third of the MCA territory?
Administration of IV alteplase (0.9 mg/kg, maximum dose 90 mg over 60 min with initial 10% of dose given as bolus over 1 min) within 4.5 h of stroke symptom recognition can be beneficial in patients with AIS who awake with stroke symptoms or have unclear time of onset >4.5 h from last known well or at baseline state and who have a DW-MRI lesion smaller than one-third of the MCA territory and no visible signal change on FLAIR. This intervention has a COR IIa and LOE B-R rating.