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Recent studies have shown that alteplase has no clear benefit over usual care in patients with acute stroke and mild, nondisabling deficits. These trials did not require vascular or perfusion imaging. Whether thrombolysis provides a benefit in patients with a confirmed vascular occlusion or perfusion deficit is unknown. To find out, investigators conducted a randomized, open-label trial of patients with mild stroke (NIH Stroke Scale score, 0–5) who had a confirmed vascular occlusion or perfusion deficit and could be treated within 12 hours after stroke onset. Outcome assessments were blinded. The primary outcome was return to the premorbid modified Rankin Scale score at 90 days. Patients were randomly assigned to tenecteplase (0.25 mg/kg) o…