Endovascular Treatment With Versus Without Intravenous rhTNK-tPA in Stroke

Prior treatment

• Already received intravenous thrombolytic after index stroke
• Current participation in another investigational drug clinical trial

Other illness

• Intracranial hemorrhage on baseline CT or MR
• Arterial tortuosity and/or other arterial disease that would lead to unstable access platform or prevent the thrombectomy device from reaching the target vessel
• Patient with a preexisting neurological or psychiatric disease that would confound the outcome assessments
• Any terminal disease with a life expectancy less than half a year

Lab values

• Known pregnancy, or breastfeeding, or serum beta human chorionic gonadotropin test is positive on admission

Other

• Contraindication to intravenous thrombolytics
• Contraindication to radiographic contrast agents, nickel, titanium metals or their alloys
• Patient with occlusions in two or more vascular territories (e.g. bilateral territories, or anterior and posterior circulation)
• Mass effect or intracranial neoplasm on baseline CT or MR (except small meningioma)
• Intracranial arteriovenous malformation or aneurysm on baseline CT or MR angiography
• Unlikely to be available for follow-up at 90 days.

• Aged 18 years or older;
• Patient with acute ischemic stroke who is eligible for intravenous thrombolysis treatment within 4.5 hours of time last known well;
• No significant prestroke functional disability: for age \<80 years, prestroke modified Rankin scale (mRS) ≤2; for age ≥80 years, prestroke mRS ≤1;
• MCA-M1 or -M2, basilar artery, or posterior cerebral artery-P1 occlusion proved by CTA/MRA;
• EVT is planned by clinical care team;
• Written informed consent is obtained from patients and/or their legal representatives.