🧠 Three major stroke trials published in JAMA this week may reshape adjunctive reperfusion strategies in acute ischemic stroke.

🔹 TNK-PLUS: Tenecteplase before thrombectomy in late-window stroke showed no added functional benefit. 🔹 CHOICE-2: Intra-arterial alteplase after successful thrombectomy improved excellent neurological recovery, though mortality signals warrant caution. 🔹 INSTANT: Early tirofiban after inadequate tenecteplase response significantly improved 90-day outcomes in non-large vessel occlusion stroke.

Together, these studies highlight a growing shift from merely reopening arteries toward optimizing microvascular reperfusion and tissue recovery.