Endovascular thrombectomy has been shown to be safe and effective for the treatment of appropriately selected patients with acute ischemic stroke up to 24 hours after symptom onset. Several trials are attempting to expand the selection criteria for thrombectomy, in the hope of finding additional populations of patients who will benefit and in an effort to improve delivery of this therapy. An important question is whether the initiation of therapy with alteplase, an intravenous thrombolytic agent that is effective for treating ischemic stroke, provides additional benefit over thrombectomy performed without preceding intravenous thrombolytic treatment. A potential advantage of a strategy.