Georgios Tsivgoulis, MD, PhD, MSc, FESO, FEAN, FAAN, National and Kapodistrian University of Athens, Athens, Greece, discusses investigations into the comparative safety and efficacy of tenecteplase versus alteplase for intravenous thrombolysis in patients with acute ischemic stroke (AIS) from large vessel occlusions (LVO). Evidence gathered to date has suggested that tenecteplase may achieve higher rates of successful reperfusion compared with alteplase, with a trend towards improved functional outcomes. Two large-scale Phase III trials will evaluate these agents head-to-head, which may provide the evidence to support tenecteplase as a superior alternative thrombolytic agent. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.