Tests tenecteplase against standard drugs for mild acute ischemic stroke

Who can take part

• 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

Who cannot take part

• 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
• 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
• 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
• 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