Window
- IV alteplase: within 4.5 h of symptom onset
- Mechanical thrombectomy: large-vessel occlusion within 6 h (up to 24 h if salvageable on imaging)
Inclusion
- NIHSS ≥4 OR disabling deficit
- CT excludes haemorrhage
- BP ≤185/110 (treat first)
Absolute exclusions
- Intracranial haemorrhage
- Major surgery / GI bleed <21 d
- Stroke / head injury <3 m
- INR >1.7, DOAC <48 h
Dose
- Alteplase 0.9 mg/kg (max 90 mg) — 10% bolus, 90% over 1 h
- No antiplatelet for 24 h post-lysis
