Advancing Reperfusion Therapy for Ischemic Stroke (ARTS): Tenecteplase in Medium Vessel Occlusion (MeVO) for Acute Ischemic Stroke

Exclusion Criteria

• •(1)Allergy to tenecteplase;
• •(2)Rapidly improving symptoms at the discretion of the investigator;
• •(3)NIHSS consciousness score 1a \>2, or epileptic seizure, hemiplegia after seizures (Todd's palsy) or other neurological/mental illness such that the patient is not able to cooperate or unwilling to cooperate;
• •(4)Intention to undergo endovascular treatment.
• •(5)Persistent blood pressure elevation (systolic ≥185 mmHg or diastolic ≥110 mmHg), despite blood pressure-lowering treatment;
• •(6)Blood glucose \<2.8 or \>22.2 mmol/L (point of care glucose testing is acceptable);
• •(7) Active internal bleeding or at high risk of bleeding, e.g., major surgery, trauma or gastrointestinal or urinary tract hemorrhage within the previous 21 days, or arterial puncture at a non-compressible site within the previous 7 days;
• •(8)Any known impairment in coagulation due to comorbid disease or anticoagulant use. If on warfarin, then INR \>1.7 or prothrombin time \>15 seconds; use of any direct thrombin inhibitors or direct factor Xa inhibitors during the last 48 hours unless reversal of dabigatran can be achieved with idarucizumab; any full dose heparin/heparinoid during the last 24 hours or with an APTT greater than the upper limit of normal;
• •(9)Known defect of platelet function or platelet count below 100,000/mm3 (NB patients taking antiplatelet medication can be included);
• •(10)Ischemic stroke or myocardial infarction in previous 3 months, previous intracranial hemorrhage, severe traumatic brain injury or intracranial or intraspinal operation in previous 3 months, or known intracranial neoplasm, arteriovenous malformation, or giant aneurysm;
• •(11)Any terminal illness such that the patient would not be expected to survive more than 1 year;
• •(12) Unable to perform CTP or PWI;
• •(13)Hypodensity in \>1/3 MCA territory on non-contrast CT or hypodensity outside the current perfusion lesion suggesting distal clot migration (secondary MeVO);
• •(14)Acute or past intracerebral hemorrhage (ICH) identified by CT or MRI;
• •(15)Pregnant women, nursing mothers, or reluctance to use effective contraceptive measures during the period of the trial;
• •(16)Unlikely to adhere to the trial protocol or follow-up;
• •(17) Participation in other interventional clinical trials within the previous 3 months.