Insurer: "This is a retrospective review of the thrombolytic." Me: "You are reviewing whether he should have gotten it." Insurer: "Correct." Me: "He got it forty minutes after the last time he was normal." Insurer: "And how did that turn out?" Me: "He is at his daughter's wedding. Is that a covered outcome?" The benefit of intravenous thrombolysis in acute ischemic stroke is steeply time-dependent — the earlier inside the window, the greater the odds of a good functional outcome. Forty minutes from last known well is about as good as that decision gets. It is now being graded by someone with the chart open and the clock closed. Send this to the person who does your peer-to-peers. Send this to whoever does your peer-to-peer calls.