Tenecteplase vs Medical Management in 4.5-24h LVO no Access to EVT

Exclusion Criteria

• •Current or past history of significant bleeding over the past 6 months;
• •History of intracranial hemorrhage (including possible subarachnoid hemorrhage or subarachnoid hemorrhage due to an aneurysm) or evidence or suspected intracranial hemorrhage;
• •Known bleeding tendency;
• •Recent severe or dangerous bleeding, or active ulcerative gastrointestinal disease;
• •History of central nervous system injury (e.g., intracranial tumor, aneurysm, or arteriovenous malformation, intracranial or spinal surgery), or recent head injury；
• •Tumors that increase risk of bleeding;
• •Severe liver dysfunction, including liver failure, cirrhosis, portal hypertension (esophageal varices), and active hepatitis;
• •Know arterial / venous malformation or aneurysm;
• •Bacterial endocarditis, pericarditis, or acute pancreatitis;
• •Patients receiving effective anticoagulant therapy (vitamin K antagonists with INR \> 1.3, or other oral anticoagulants exceeding the upper limit of the corresponding standard range);
• •Heparin use within the past 48 hours and prothrombin time exceeding the upper limit of the standard range;
• •Over the past 3 months, undergone major surgery, organ biopsy, or suffered a serious injury;
• •Over the past 2 weeks, receiving prolonged ( \>2 minutes) cardiopulmonary resuscitation, childbirth, or non-stressful vascular puncture (such as subclavian or jugular vein puncture);
• •Stroke episode occurred with epileptic seizure;
• •History of stroke comorbid with diabetes;
• •History of stroke over the past 3 months；
• •Acute bleeding tendency, including platelet count below 100×10⁹/L or other conditions;
• •SBP \>185 mmHg or DBP \>110 mmHg, or requiring intensive treatment (intravenous antihypertensive drugs) to lower blood pressure to within limits;
• •Blood glucose \<2.8 mmol/L or \>22.2 mmol/L (\<50 mg/dL or \>400 mg/dL)；
• •Patient life expectancy of less than 1 year;
• •Simultaneous occlusion of multiple blood vessels, defined as bilateral MCAs or MCAs combined with the basilar artery;
• •Pregnant women or nursing mothers；
• •Patients with a low likelihood of 3-month follow-up；
• •Over the past 3 months participated in other interventional clinical trials.