A Bayesian network meta-analysis of 15 randomized trials found that endovascular thrombectomy delivers the clearest benefit for extended-window stroke patients with confirmed large-vessel occlusion. Bridging tenecteplase showed favorable but statistically inconclusive results in the same extended-window setting. The analysis reinforces current trial-driven practice patterns that rely on imaging-confirmed LVO status rather than time alone. For guideline committees and stroke programs, the findings emphasize evidence quality differences between endovascular strategies and pharmacologic bridging across subpopulations. The result also supports more consistent trial designs around eligibility criteria, since misclassification of LVO or patient heterogeneity can blur treatment effects.