Current guidelines from the American Heart Association/American Stroke Association advocate against the administration of intravenous thrombolysis (IVT) in patients with acute ischaemic stroke (AIS) with a prior ischaemic stroke (IS) within 3 months (Class III: Level of Evidence B).1 This concern is based on a presumed increased risk of symptomatic intracranial haemorrhage (sICH) and mortality2 and therefore led to the respective guideline recommendation. Thus, patients with a history of prior IS have been excluded in the majority of the pivotal randomised controlled clinical trials that have established IVT as a treatment for . To read the full article, log in using your NHS OpenAthens details.