Teneteplase Reperfusion Therapy in Acute Ischemic Cerebrovascular Events-Ⅳ

Prior treatment

• Severe head trauma or previous stroke within 3 months；
• Intracranial or spinal surgery within 3 months;
• Major surgery within 2 weeks;
• Use of thrombin inhibitors or factor Xa inhibitors within 48 hours;
• Participation in another clinical trial within 3 months prior to screening;

Other illness

• Known allergic to rhTNK-tPA;
• History of intracranial hemorrhage;
• Gastrointestinal or urinary tract hemorrhage within 3 weeks；
• Intracranial hemorrhage, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and subdural/epidural hematoma;
• Active visceral bleeding;
• Uncontrolled hypertension after active antihypertensive treatment: systolic blood pressure \>180 mm Hg or diastolic \>100 mm Hg;
• Todd's paralysis after a seizure or other neurological/psychiatric disorders affecting cooperation;
• Severe, uncontrolled infections (e.g., acute pericarditis, infective endocarditis, or acute pancreatitis);
• Other severe illnesses with a life expectancy of less than six months;

Lab values

• Acute bleeding tendency, including platelet count \<100×10⁹/L or other clinically significant conditions;
• Blood glucose \< 2.8 or \> 22.2 mmol / L;
• Prior anticoagulant therapy, such as oral warfarin, with an INR \>1.7 or PT \>15 seconds;

Other

• Planned or likely acute endovascular treatments before randomization;
• NIHSS 1a \> 2;
• Arterial puncture at a non-compressible site within 1 week；
• Intracranial tumors (excluding neuroectodermal tumors, e.g., meningiomas), large intracranial aneurysms, or arteriovenous malformations；
• Concomitantaortic arch dissection;
• Use of heparin within 24 hours;
• Large cerebral infarction on head CT or MRI (infarction area \>1/3 of the middle cerebral artery territory);
• Pregnant or breastfeeding women, or women unwilling to use effective contraception during the study period;
• Deemed unsuitable for the study or at increased risk by the investigator's judgment.

• Age ≥ 18 years;
• Onset-to-treatment time \< 4.5 h; onset time defined as "last known well" time;
• Clinical diagnosis of minor ischemic stroke (NIHSS ≤ 5) with persistent unilateral limb weakness or speech symptoms, defined as a score of ≥1 on either the language item or a single limb item of the NIHSS;
• Pre-stroke mRS 0-1;
• Informed consent signed.