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Clinical trials demonstrate potential advantages, including improved reperfusion rates and functional outcomes with lower systemic bleeding. Though not officially approved for this purpose by all regulatory agencies, TNK is used off-label and in acute stroke guidelines due to its ease of administration and effectiveness. The 0.25\u2009mg\/kg dosage within 4.5\u2009hours of symptom onset was shown to be consistently effective and safe. Further trials are expected to identify patient subgroups that benefit most from TNK treatment. The present narrative review assesses the existing literature and evidence regarding the use of tenecteplase for the treatment of acute ischemic stroke.<\/jats:p>","DOI":"10.1055\/s-0045-1808088","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T22:36:22Z","timestamp":1748817382000},"page":"001-011","source":"Crossref","is-referenced-by-count":5,"title":["Tenecteplase in acute ischemic stroke: a new era in thrombolysis"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3247-3123","authenticated-orcid":false,"given":"Gisele Sampaio","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."},{"name":"Hospital Israelita Albert Einstein, Centro de Ensino e Pesquisa, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-3919","authenticated-orcid":false,"given":"Eva","family":"Rocha","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0317-843X","authenticated-orcid":false,"given":"Oct\u00e1vio Marques","family":"Pontes-Neto","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8452-712X","authenticated-orcid":false,"given":"Sheila 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