Acute ischemic stroke

ICD-10 I63 · guideline questions traced from the recommendation down to the data it rests on.

Acute ischemic stroke is a setting where minutes decide outcomes and the evidence turns over quickly, so the recommendations are a good test of how well a guideline sentence tracks the data behind it. The questions worth tracing here are about what the trials actually established, and what kind of claim a guideline is making when it lets one option stand in for another.

Traces Back to the pathway →

Published · model and estimate rungs

Tenecteplase versus alteplase for thrombolysis

Alteplase was the standard intravenous thrombolytic for acute ischemic stroke for decades. Tenecteplase, given as a single bolus instead of a bolus plus an hour-long infusion, is now its co-equal: in 2026 the AHA/ASA gave both a Class 1 recommendation. This trace walks that recommendation down to the trials, where the strongest head-to-head evidence is non-inferiority, not superiority, and asks what a “not worse by more than a chosen margin” result, plus a logistical advantage, can and cannot support.

Read the trace →

Other acute-ischemic-stroke questions will be traced here as each is worked and sourced: the extended time window for endovascular thrombectomy and the imaging selection behind it, and blood-pressure management around reperfusion.

Each trace is methodological commentary, not clinical advice. It is about what the numbers can and cannot support, not guidance for treating a patient. If you have a stroke recommendation whose statistical basis you want traced, for a manuscript or your own appraisal, book a discovery call →.