Efficacy and Safety of Tenecteplase Bridging Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke

Prior treatment

• Intracranial or intraspinal surgery within the past 3 months.
• Major surgery within the past 2 weeks.
• Heparin treatment received within the past 24 hours.
• Use of direct thrombin inhibitors or direct Factor Xa inhibitors within the past 48 hours.

Other illness

• Patients diagnosed with hemorrhagic stroke (including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural/extradural hematoma, etc.) or other related conditions identified by CT.
• History of intracranial hemorrhage.
• History of severe head trauma or stroke within the past 3 months.
• Gastrointestinal or urinary tract bleeding within the past 3 weeks.
• Active visceral bleeding.
• Uncontrolled hypertension despite active antihypertensive treatment: Systolic Blood Pressure \> 180 mmHg or Diastolic Blood Pressure \> 100 mmHg.
• Any terminal illness where life expectancy is considered not to exceed 1 year.
• Any condition where, in the judgment of the investigator, the study treatment might pose a risk to the patient or affect the patient's participation in the study.
• Known allergy to the active ingredients (Alteplase, Tenecteplase) or any excipients.

Lab values

• Acute hemorrhagic tendency, including platelet count \< 100 × 10⁹/L or other conditions.
• For patients on oral anticoagulants: INR \> 1.7 or PT \> 15 seconds.
• Blood glucose \< 2.8 mmol/L or \> 22.2 mmol/L.

Other

• Contraindication to imaging examinations involving contrast agent injection.
• Patients presenting with clinical symptoms of coma (NIHSS Score Item 1a = 3).
• Intracranial tumor, arteriovenous malformation, or giant intracranial aneurysm.
• Aortic arch dissection.
• Arterial puncture at a non-compressible site within the past week.
• Hypodensity affecting \> 1/3 of the middle cerebral artery territory or an equivalent proportion of the basilar artery territory on non-contrast CT.
• Rapidly improving symptoms as determined by the investigator.
• Participation as a subject in another research study within the past 30 days.
• Pregnant women.

• Age is ≥18 years.
• AIS symptom onset ≤4.5 hours, onset time refers to the time the patient was last known to be well. (Recommendation time from thrombolysis to puncture within 60 minutes).
• Arterial occlusion of the internal carotid artery (ICA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), M1 or M2 segment of the middle cerebral artery (MCA), or basilar artery on computed tomography angiography (CTA) or magnetic resonance angiography (MRA).
• Prestroke mRS score ≤2.
• Informed consent from the patient or legally authorised representative.