Superiority of Rt-PA + Tenecteplase in Comparison With Rt-PA Only in Proximal Middle Cerebral Artery Occlusion

Exclusion Criteria

• •Contraindication to MRI
• •Contraindication to rt-PA administration
• •Contraindication to TNK administration
• •Contraindication to stroke thrombolysis
• •Refusal to sign the informed consent
• •Extensive small arteries disease (\>5 microbleed and/or Fazekas score≥3)
• •Systolic arterial pression\> 185 mmHg or diastolic arterial pression \> 110 mmHg
• •Glycemia \< 3 mmol/l (0,5g/l) or \> 22 mmol/l (4g/l)
• •Thrombopenia \< 100 000/mm3 or INR \> 1,5.
• •Patients treated with new oral anticoagulant.
• •Seizure as one of acute stroke symptoms
• •Lumbar or arterial puncture in the previous 7 days or major surgery in the previous 15 days
• •Carotid occlusion associated with MCA occlusion
• •Thrombus length \> 12mm assessed on gradient echo sequences
• •Large DWI lesion, defined as ASPECTS \< 7 / 10
• •DWI/PWI Mismatch \< 20% (when performed) on MRI 2
• •Marked FLAIR hypersignal on cortical structure and light hypersignal on caudate or lenticular nucleus assessed on MRI 2.
• •Parenchymal hemorrhage on MRI 2
• •Pregnancy or breast feeding
• •Patient currently included in a biomedical study