Though pilot studies have suggested that tenecteplase, which is more fibrin-specific and easier to deliver, might be an alternative to alteplase, this study failed to show a difference when administered within 4.5 hours of stroke onset. According to a commentary, through selection of a prospective randomised open-label blinded end-point design, CT, CT angiography, and CT perfusion selection parameters, and initiation of treatment before advanced imaging, this trial favoured pragmatism, speed, and generalisability, but paid a steep price in the proportion eligible for the primary endpoint analysis (the researchers had estimated a potential 25% reduction in mean infarct volume equating to 52 patients per group for 80% power at 5% level of significance). All of these factors could have contributed to the lack of difference between the two drugs. The commentator notes that studies such as this one are crucial to discover such new intravenous therapies that could offer thrombolysis to a wider population of patients