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The structure of tenecteplase differs from alteplase by three amino acids, a difference that results in a longer a half-life and the ability to administer tenecteplase as a single intravenous bolus. Although the use of tenecteplase for stroke remains off-label, multiple clinical trials have demonstrated its noninferiority to alteplase for acute ischemic stroke. Whether the efficacy or safety profile of tenecteplase differs in certain subpopulations is less clear. Researchers examined this question using data from 71 patients presenting within 4.5 hours of symptom onset with an extracranial stenosis or occlusion of the internal carotid artery and an intracranial large-vessel occlusion — i.e., a tandem lesion — out of 483 total patients from …