Stroke thrombolysis is rapidly evolving and tenecteplase is emerging as one of the most exciting developments in acute ischemic stroke care. In this episode, we explore how a simple change from a one-hour infusion to a single IV bolus could transform stroke treatment workflows, improve transfer logistics, and potentially enhance early reperfusion in some patients. We unpack the science behind tenecteplase, review the landmark trials that challenged alteplase’s decades-long dominance, and discuss why clinicians around the world are paying close attention. From breakthrough studies in large vessel occlusion to major safety and non-inferiority trials, this episode highlights the evidence shaping modern stroke practice. This episode offers a practical and engaging overview of one of the biggest shifts in contemporary stroke care.