Intravenous Tenecteplase Plus EVT Versus EVT Alone on 4.5 to 24 Hours After Basilar Artery Occlusion

Prior treatment

• Systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg, which cannot be controlled by antihypertensive drugs;
• Patients who received intravenous thrombolytics treatment before the randomization;

Other illness

• CT or MR evidence of intracerebral hemorrhage (the presence of \< 10 microbleeds is allowed);
• Pre-stroke modified Rankin scale (mRS) score of ≥ 2;
• Posterior circulation Acute Stroke Prognosis Early CT Score (PC-ASPECTS) on CT/ CTA-Source Images\<6; PC-ASPECTS on magnetic resonance imaging-diffusion weighted imaging (MRI-DWI) \<5;
• Allergy to contrast agent or nitinol alloy;
• The patient had a history of or clinical suspicion for cerebral vasculitis or infectious endocarditis;
• The patient has nervous system disease or mental disorder before stroke onset, which may affect the assessment of their condition;

Lab values

• Genetic or acquired hemorrhagic diathesis, lack of anticoagulant factor; or oral anticoagulant with international normalized ratio (INR) \> 1.7, or novel oral anticoagulant within prior 48 hours;
• Blood glucose \<50 mg/dl (2.8 mmol/L) or \>400 mg/dl (22.2 mmol/L), platelet\< 100\*109/L;
• Renal insufficiency defined as serum creatinine \>2.0 mg/dl (or 176.8 μ mol/l) or a glomerular filtration rate \<30 mL/min or the need for hemodialysis or peritoneal dialysis;

Other

• Pregnant or lactating women;
• Life expectancy\<1 year;
• CTA/MRA/DSA show vascular tortuosity, vascular variation or artery dissection, which would make it difficult to perform endovascular treatment;
• Participating in other clinical trials;
• Patients who cannot complete 90-day follow-up (such as patients without fixed residence, overseas patients, etc);
• The patient has acute ischemic cerebral infarction within 3 months from randomization;
• CT or MR examination showed large cerebellar infarction with obvious space occupying effect and compression of the fourth ventricle;
• Patients with extensive bilateral thalamic or extensive bilateral brainstem infarction on CT or MR examination;
• CTA/MRA/DSA show both anterior and posterior circulation large vessel occlusion;
• Patients with intracranial tumors (except small meningiomas);

• Patients presenting with posterior circulation ischemic stroke symptoms due to basilar artery occlusion or vertebral artery occlusions that prevent antegrade flow into the basilar artery;
• Time from stroke onset to randomization within 4.5-24 hours of estimated time of basilar artery occlusion;
• Patient's age≥18 years;
• Presence of basilar artery or vertebral artery occlusion, confirmed by CT Angiography (CTA), MR Angiography (MRA) or Digital Subtraction Angiography (DSA). In cases of vertebral artery occlusion, the occlusion must completely prevent antegrade flow into the basilar artery;
• Patients presenting with acute ischemic stroke eligible using standard criteria (except for time window) to receive both endovascular thrombectomy and intravenous thrombolysis;
• Baseline National Institutes of Health Stroke Scale (NIHSS) score≥ 10 at the time of neuroimaging;
• The patient or patient's legal representative signs the informed consent form.