EXtending the Time Window for Thrombolysis in Posterior Circulation Stroke Without Early CT Signs

Exclusion Criteria

• •1. Intended to proceed to endovascular treatment
• •2. Contraindications for alteplase:
• •* Allergy to alteplase
• •* Rapidly improving symptoms at the discretion of the investigator
• •* The presence of epileptic seizures, hemiplegia after seizures (Todd's palsy), or other neurological/mental illnesses that prevent cooperation or willingness to participate
• •* Persistent blood pressure elevation (systolic ≥180 mmHg or diastolic ≥100 mmHg) despite treatment
• •* Blood glucose levels outside the acceptable range (\<2.8 mmol/L or \>22.2 mmol/L), with point-of-care glucose testing considered valid
• •* High risk of bleeding due to active internal bleeding, major surgery, trauma, gastrointestinal, or urinary tract hemorrhage within the previous 21 days, or arterial puncture at a non-compressible site within the previous 7 days
• •* Known impairments in coagulation due to comorbid disease or anticoagulant use, including an INR \>1.7 or prothrombin time \>15 seconds for those on warfarin, recent use of direct thrombin inhibitors or direct factor Xa inhibitors without reversal capability, or full-dose heparin/heparinoid within the last 24 hours with an aPTT above normal limits
• •* Known defect in platelet function or a platelet count below 100,000/mm³
• •* History of ischemic stroke, myocardial infarction, intracranial hemorrhage, severe traumatic brain injury, or intraspinal operation within the previous 3 months, or known intracranial neoplasm, arteriovenous malformation, or giant aneurysm
• •* Acute or past intracerebral hemorrhage identified by CT or MRI
• •3. Infarction of the anterior circulation confirmed by MRI, or vascular examination indicating occlusion of large anterior circulation vessels, or perfusion imaging showing hypoperfusion changes in the anterior circulation area
• •4. Pregnancy, nursing, or unwillingness to use effective contraceptive measures during the trial period
• •5. Likelihood of non-adherence to the trial protocol or follow-up
• •6. Any condition that, in the judgment of the investigator, could impose hazards if study therapy is initiated or affect patient participation in the study
• •7. Participation in other interventional clinical trials within the previous 3 months
• •8. A life expectancy of less than three months
• •9. The judgment is left to the discretion of the investigator