Reperfusion Completion Via Local Arterial Infusion of Tenecteplase After Incomplete Mechanical Thrombectomy

Prior treatment

• Systolic blood pressure ≥ 185 mmHg or diastolic blood pressure ≥ 110 mmHg, refractory to antihypertensive medication;

Other illness

• DSA post-thrombectomy indicating dissection of the occluded artery, or intra-procedural flat-panel CT suggesting local hemorrhage or significant contrast extravasation;
• Severe allergy or absolute contraindication to iodinated contrast media;
• Pre-existing neurological or psychiatric disease that would interfere with the assessment of outcomes;
• Any other condition deemed by the investigator to make the patient unsuitable for participation or to pose a significant risk to the patient.

Lab values

• Blood glucose \< 50 mg/dL (2.8 mmol/L) or \> 400 mg/dL (22.2 mmol/L);
• Platelet count \< 50 × 10⁹/L, or APTT \> 40 s, or PT \> 15 s;
• Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency; or current use of oral anticoagulants with INR \> 1.7;
• Severe renal failure, defined as serum creatinine \> 3.0 mg/dL (or 265.2 μmol/L) or glomerular filtration rate \[GFR\] \< 30 mL/min, or requiring hemodialysis or peritoneal dialysis;

Other

• Contraindications to intravenous thrombolysis (excluding time-based criteria);
• Baseline NIHSS score not obtained;
• Patient unlikely to complete the 90-day follow-up (e.g., no fixed address, palliative care patient, etc.);
• Suspected vasculitis or septic embolism;
• Suspected aortic dissection;
• Pregnancy or lactation;
• Current participation in another clinical trial that could interfere with this study;

• Age ≥ 18 years;
• Time from symptom onset or last known well to randomization within 24 hours;
• Clinical diagnosis of acute ischemic stroke caused by acute occlusion of the intracranial anterior circulation large vessels confirmed by CTA/MRA/DSA, including occlusion of the intracranial segment of the internal carotid artery, the M1 or M2 segments of the middle cerebral artery, with or without concomitant occlusion of the ipsilateral extracranial segment of the internal carotid artery;
• NIHSS score ≥ 6, and meeting the current guidelines for mechanical thrombectomy;
• Anterior circulation large vessel stroke due to occlusion of the intracranial ICA, MCA M1, or M2 segments;
• Pre-stroke mRS score ≤ 1;
• ASPECTS score ≥ 6;
• Post-mechanical thrombectomy status with 2b ≤ eTICI \< 3, and the operator has decided not to attempt further mechanical recanalization of the occluded vessel;
• No more than 3 passes with the thrombectomy device;
• Signed informed consent obtained from the patient or their legal guardian.