Campbell BCV, et al. - Through a systematic review and meta-analysis of individual patient data from three trials that met eligibility criteria (EXTEND, ECASS4-EXTEND, and EPITHET) that included 414 participants in total, researchers assessed if perfusion imaging could recognize those with salvageable brain tissue with symptoms 4.5 hours or more from stroke onset or with symptoms on waking who could profit from thrombolysis. Out of the 414, 213 participants were allocated to receive alteplase and 201 to receive a placebo. A total of 76 of the 211 patients in the alteplase group and 58 of 199 in the placebo group attained excellent functional results at 3 months. In the alteplase group vs the placebo group, symptomatic intracerebral hemorrhage was more prevalent. In the alteplase group and in the placebo group, 29 of 213 patients and 18 of 201 patients, respectively, died. Compared to those who were given a placebo, subjects with ischemic stroke 4.5–9 hours from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase obtained better functional results. Even though the rate of symptomatic intracerebral hemorrhage was greater with alteplase, this increase did not negate the overall net profit of thrombolysis.