This study aims to evaluate the efficacy and safety of tenecteplase (TNK) intravenous thrombolysis within the extended time window (4.5 to 24 hours) in patients with acute posterior circulation ischemic stroke.
Age ≥18 years.
Meeting at least one of the following criteria: acute posterior circulation ischemic stroke confirmed by MRI; symptomatic stenosis or occlusion of a posterior circulation large vessel on vascular imaging (CTA/MRA/DSA); perfusion imaging demonstrating clinically relevant hypoperfusion in the posterior circulation territory.
Onset time between 4.5-24 hours (for wake-up stroke or unwitnessed stroke, onset time is defined as the midpoint between last known well and symptom detection).
NIHSS score>3.
Contraindication to tenecteplase or its components.
Planing to receive endovascular therapy with thrombectomy, angioplasty or stenting whin 3 months.
Acute anterior circulation infarction confirmed by MRI, anterior circulation large vessel occlusion on vascular imaging (CTA/MRA/DSA), or anterior circulation hypoperfusion on perfusion imaging.
History of intracranial hemorrhage.
Parallel
TNK plus standard medical treatment
DrugPatients in the TNK treatment group will receive TNK intravenous thrombolysis and the usual dosage for TNK intravenous thrombolysis is 0.25mg/Kg, with a maximum of 25mg.
standard medical management
Drugstandard medical management
Proportion of patients with modified Rankin Scale (mRS) score 0-1 at 90 ±14 days;
Proportion of patients with mRS score 0-2 at 90 ±14 days;
Proportion of patients with mRS score 0-3 at 90 ±14 days;
Ordinal distribution of mRS score at 90 ±14 days;
Change in NIHSS score at 24-36 hours post-treatment
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