Extending the Time Window for Tenecteplase by Recanalization of Basilar Artery Occlusion in Posterior Circulation Stroke

Inclusion Criteria:

• Patients presenting with posterior circulation ischemic stroke symptoms due to partialor complete basilar artery occlusion within 24 hours from symptom onset (or clinicaldeterioration/coma) or the time the patient was last known to be well.
• Patient's age is ≥18 years
• Presence of basilar artery occlusion, proven by CT Angiography or MR Angiography.Basilar artery occlusion is defined as 'potentially retrievable' occlusion at thebasilar artery. This can be a partial or complete occlusion.
• Premorbid mRS ≤3 (independent function or requiring only minor domestic assistance andable to manage alone for at least 1 week).
• Local legal requirements for consent have been satisfied.

Exclusion Criteria:

• Intracerebral hemorrhage (ICH) or other diagnosis (e.g. tumour) identified by baselineimaging.
• Posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) <7 onnon-contrast CT, CT Angiography source images or DWI MRI.
• Significant cerebellar mass effect or acute hydrocephalus.
• Established frank hypodensity on non-contrast CT indicating subacute infarction.
• Bilateral extensive brainstem ischemia.
• Strong suspicion of underlying intracranial atherosclerotic disease (e.g diffusearterial calcifications, basilar stenosis) or dissection which may require immediateneuro-interventional procedure with intracranial stenting and not benefit fromintravenous thrombolysis at investigator's discretion.
• Pre-stroke mRS of ≥4 (indicating moderate to severe previous disability).
• Other standard contraindications to intravenous thrombolysis.
• Contraindication to imaging with contrast agents.
• Clinically evident pregnant women.
• Current participation in another research drug treatment protocol.
• Known terminal illness such that the patients would not be expected to survive a year.
• Planned withdrawal of care or comfort care measures.
• Any condition that, in the judgment of the investigator could impose hazards to thepatient if study therapy is initiated or affect the participation of the patient inthe study.