Treatment may be reasonable if there is the potential for substantial benefit. (COR IIb; Level B-NR) Concomitant tirofiban, epifibatide The efficacy of the IV glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide coadministered with IV alteplase is not well established. (COR IIb; Level B-NR) Extra-axial intracranial neoplasms IV alteplase treatment is probably recommended for patients with AIS who harbor an extra-axial intracranial neoplasm. (COR IIa; LOE C-EO) Acute MI For patients presenting with concurrent AIS and acute MI, treatment with IV alteplase at the dose appropriate for cerebral ischemia, followed by percutaneous coronary angioplasty and stenting if indicated, is reasonable. (COR IIa; LOE C-EO) Recent MI For patients presenting with AIS and a history of recent MI in the past 3 mo, treating the ischemic stroke with IV alteplase is reasonable if the recent MI was non-STEMI. (COR IIa; LOE C-LD) For patients presenting with AIS and a history of recent MI in the past 3 mo, treating the ischemic stroke with IV alteplase is reasonable if the recent MI was a STEMI involving the right or inferior myocardium. (COR IIa; LOE C-LD) For patients presenting with AIS and a history of recent MI in the past 3 mo, treating the ischemic stroke with IV alteplase may be reasonable if the recent MI was a STEMI involving the left anterior myocardium. (COR IIb; LOE C-LD) Acute pericarditis For patients with major AIS likely to produce severe disability and acute pericarditis, treatment with IV alteplase may be reasonable (COR IIb; LOE C-EO) ; urgent consultation with a cardiologist is recommended in this situation. For patients presenting with moderate AIS likely to produce mild disability and acute pericarditis, treatment with IV alteplase is of uncertain net benefit. 