Early Recanalization After Intravenous Thrombolysis With Tenecteplase Versus Alteplase in Distal Vessel Occlusion Strokes

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• Patients informed of the study who objected to the collection of their data.

• Age≥ 18 years.
• Acute ischemic stroke (visible on DWI, but not visible on FLAIR) on initial MRI associated with distal arterial occlusion as defined below:
  • A distal occlusion of the M2 segment of the middle cerebral artery (MCA)
  • Occlusion (regardless of location) of a non-dominant M2 branch of the MCA
  • Occlusion of the M3 segment of the MCA.
  • Occlusion of the A2 or A3 segment of the anterior cerebral artery (ACA)
  • Occlusion of the P2 or P3 branch of the posterior cerebral artery (PCA).
  • A proximal M2-MCA or proximal P1-PCA occlusion may also be included if not eligible for mechanical thrombectomy, especially if the initial NIHSS score is low (<5).
  • Distal arterial occlusion is identified by MRI either on the TOF (Time of Flight)-ARM sequence and/or on the presence of a thrombus (Susceptibility Vessel sign, SVS) on the SWAN sequence,
• IVT by ALT or TNK within 4H30 after onset of symptoms,
• Early brain MRI performed 1 to 2 hours after IVT (MRI n°2),
• Good quality MRI (absence of motion artifact interfering with interpretation) with availability of DWI, FLAIR, TOF-MRA and SWAN sequences.