Tenecteplase Before Interhospital Transfer for EVT in Acute Anterior Circulation LVO at 4.5-24 Hours

Exclusion Criteria

• •Known hypersensitivity or allergy to any ingredients of Tenecteplase;
• •Intended to receive IVT as standard-of-care therapy;
• •Rapidly improving symptoms with NIHSS score \<6 before randomization;
• •Any contra-indication for IVT except for the time criterion;
• •Known hereditary or acquired hemorrhagic diathesis;
• •Impairment in coagulation due to comorbid disease or anticoagulant use. If on warfarin, INR \>1.7 or prothrombin time \>15s; if use of any direct oral anticoagulant within the last 48 hours; if on any full dose heparin/heparinoid within the last 24 hours;
• •Ischemic stroke or myocardial infarction in previous 3 months
• •Previous intracranial hemorrhage, active internal bleeding (gastrointestinal or urinary tract hemorrhage) in previous 3 months;
• •Severe, uncontrolled hypertension (systolic blood pressure \>180 mmHg or diastolic blood pressure \>110 mmHg);
• •Other serious, advanced or terminal illness with life expectancy less than 6 months;
• •Baseline blood glucose \<50mg/dl or \>400mg/dl;
• •Contraindication to imaging with contrast agents;
• •Acute symptomatic arterial occlusions in more than one vascular territory confirmed on CTA or MRA (e.g. bilateral MCA occlusions, or an MCA and a basilar artery occlusion);
• •Extensive early ischemic change on non-contrast CT or MRI-DWI estimated to be \>1/3 MCA territory, or significant hypodensity outside the Tmax\>6s perfusion lesion that invalidates mismatch criteria (if patient is enrolled based on CT perfusion criteria);
• •Evidence of intracranial tumor (mass effect), acute intracranial hemorrhage, or arteriovenous malformation;
• •Current participation in another investigational drug or device study;
• •Suspected endocarditis;
• •Any condition that, in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study;