To assess the safety and efficacy of beyond time window TNK intravenous thrombolysis for distal Medium Vessel Occlusion (MeVO) related stroke in a prospective randomized clinical trial.
Evidence of a primary (e.g., not secondary to endovascular therapy of proximal vessel occlusion) distal medium vascular occlusion defined as occlusion of the co/non-dominant M2 segment*, M3, or M4 segment of the middle cerebral artery (MCA), the anterior cerebral artery (ACA) (A1, A2, A3, or A4 segments), or the posterior cerebral artery (PCA) (P1, P2, P3, or P4 segments);
Age ≥18 years;
Premorbid mRS 0-1;
Baseline National Institutes of Health Stroke Scale (NIHSS) score ≥4 at the time of randomization.
Received intravenous thrombolysis prior to randomization;
Allergy to Tenecteplase;
Seizures, or other neurological/mental illness at stroke onset if it precludes obtaining an accurate baseline NIHSS;
Patients planned to undergo MT or other endovascular treatments (e.g., intra-arterial thrombolysis);