Re: The choice of intravenous thrombolysis for Acute Ischemic Stroke under COVID-19 infection

While early revascularization, through either intravenous thrombolysis (IVT) within the first 4.5 h of symptom onset, or mechanical thrombectomy is critical in preventing further irreversible damage to the brain tissue [8,9], several precautionary measures including mandatory universal SARS-CoV-2 screening for all of the patients at the time of presentation to the emergency department (ED), pursuing infection control and preventive measures, management of other SARS-CoV-2 infection related symptoms in the case of coexistence of SARS-CoV-2 infection and AIS and heavy burden of the SARS-CoV-2 infection related issues on the ED personnel, physicians and imaging facilities along with collateral effect of COVID-19 [10] have all contributed toward a significant delay of acute treatment and subsequently an increase in the AIS related mortality and morbidity during the current pandemic [8,11,12]. National shortages of Alteplase secondary to supply chain disruption after emerging SARS-CoV-2 infection, requiring an infusion dose which takes 60 extra minutes, need for a second IV access and a pump (which might be associated with risk of SARS-CoV-2 contamination) and needed time for weight measurement and weight-based dose calculation are all downsides of Alteplase compared with a single dose administration of Tenecteplase in the management of AIS [13]. While Tenecteplase offers a comparable safety and efficacy profile and superior potential for recanalization compared with Alteplase, its workflow, time saving, financial and overall infection risk reduction benefits makes it an ideal option for management of AIS during the current COVID-19 pandemic [13].