According to a commentary, these data are important and in line with a nationwide follow-up study in Denmark, providing a solid basis in favour of an effective treatment for a devastating neurological emergency. It adds that although alteplase has the potential to harm the individual patient, it has been shown to be cost-effective over the patient’s lifetime. The commentator notes two important issues about this trial which deserve further consideration. First, similar to a previous report from the IST-3 group, risk of death in patients given alteplase was increased beyond 7 days for about 4 months. Second, the finding that patients who survived the first 7 days after alteplase treatment had an increased long-term survival compared with those given standard care only.