Efficacy and Safety of Tenecteplase Intravenous Thrombolysis in Acute Posterior Circulation Ischemic Stroke Within 4.5-24 Hours After Onset

Ki vehet részt

• Age ≥18 years
• Meeting at least one of the following criteria: acute posterior circulation ischemic stroke confirmed by MRI; symptomatic stenosis or occlusion of a posterior circulation large vessel on vascular imaging (CTA/MRA/DSA); perfusion imaging demonstrating clinically relevant hypoperfusion in the posterior circulation territory
• Onset time between 4.5-24 hours (for wake-up stroke or unwitnessed stroke, onset time is defined as the midpoint between last known well and symptom detection)
• NIHSS score>3
• PC-ASPECTS ≥7 (if discrepancy exists between DWI and CT findings, CT assessment takes precedence)
• Pre-stroke mRS ≤1
• Signed informed consent by the patient or legally authorized representative

Ki nem vehet részt

• Planing to receive endovascular therapy with thrombectomy, angioplasty or stenting whin 3 months
• History of intracranial hemorrhage
• Stroke, myocardial infarction, severe traumatic brain injury, or intracranial/spinal surgery within the preceding 3 months
• Active internal bleeding, major surgery, trauma, gastrointestinal/urinary tract bleeding within 3 weeks
• Uncontrolled hypertension (systolic BP >180 mmHg or diastolic BP >110 mmHg unresponsive to antihypertensive therapy)
• Clinically significant bleeding or coagulopathy, including: Warfarin use with INR >1.7 or PT >15 s; Low-molecular-weight heparin within 24 hours; Direct oral anticoagulants within 48 hours; Laboratory abnormalities (e.g., APTT >40 s)
• Platelet dysfunction or platelet count <100×10⁹/L
• Uncontrolled hypoglycemia/hyperglycemia (<50 mg/dL [2.8 mmol/L] or >400 mg/dL [22.2 mmol/L])
• Contraindication to tenecteplase or its components
• Acute anterior circulation infarction confirmed by MRI, anterior circulation large vessel occlusion on vascular imaging (CTA/MRA/DSA), or anterior circulation hypoperfusion on perfusion imaging
• Intracranial tumor, arteriovenous malformation (AVM), or giant aneurysm
• Non-compressible arterial puncture within 1 week
• Suspected aortic dissection
• Pregnancy or lactation
• A life expectancy of less than three months
• Participation in other clinical trials within 3 months or ongoing trial enrollment
• Inability to follow up (e.g., no fixed residence, overseas patients)
• Patient deemed unsuitable for the trial by site investigator