1. Use TNK for thrombolysis:  Tenecteplase (0.25 mg/kg, max 25mg) has become standard. Its single-bolus delivery eliminates errors and it is the preferred agent for patients being transferred for thrombectomy

2.  Large Infarcts are no longer a "No": Patients with large core infarcts may qualify for EVT.

Don't let a "large stroke" on initial CT stop a stat stroke consult.

3. Posterior Stroke is a Surgical Emergency: The 24-hour window for EVT is now standard for basilar artery occlusions. Have a low threshold for CTA in patients with "Dizzy-Plus" symptoms (vertigo/truncal ataxia/diplopia) to avoid missing a posterior LVO.

4. Seizure at stroke onset does not preclude EVT. While concern exists for Todd’s paralysis mimicking ischemic stroke, treatment should not be withheld when clinical presentation and imaging support an underlying vascular occlusion.

5. Advanced Imaging for "Late" Presentations may help: For patients in the 4.5–9 hour window or those with wake-up strokes, IV thrombolysis is now recommended if CT Perfusion or MRI shows a penumbral mismatch (salvageable tissue), moving beyond the strict 4.5-hour "cutoff".