ProUrokinase for Mild Ischemic Cerebrovascular Events (PUMICE)

Inclusion Criteria:

1. Age ≥18 years, any gender;

2. Acute ischemic stroke symptom onset within 4.5 hours prior to enrollment; onset timerefers to 'last-seen normal time';

3. Pre-stroke mRS score≤ 1;

4. Baseline NIHSS ≤ 5 (both included);

5. Written informed consent from patients or their legally authorized representatives

Exclusion Criteria:

1. Rapidly improving symptoms at the discretion of the investigator;

2. Intended to proceed to endovascular treatment during 90 days (including mechanicalthrombectomy, stent insertion or balloon expansion);

3. Allergy to rhPro-UK and it's components (human albumin, mannitol);

4. NIHSS consciousness score 1a >2, or epileptic seizure, hemiplegia after seizures (Todd's palsy) or combined with other nervous/mental illness unable to cooperate orunwilling to cooperate;

5. Persistent blood pressure elevation (systolic ≥180 mmHg or diastolic ≥100 mmHg),despite blood pressure lowering treatment;

6. Blood glucose <2.8 or >22.2 mmol/L (point of care glucose testing is acceptable);

7. Active internal bleeding or at high risk of bleeding, e.g.: Major surgery, trauma orgastrointestinal or urinary tract haemorrhage within the previous 21 days, orarterial puncture at a non-compressible site within the previous 7 days;

8. Any known impairment in coagulation due to comorbid disease or anticoagulant use. Ifon warfarin, then INR >1.7 or prothrombin time >15 seconds; if use of any directthrombin inhibitors or direct factor Xa inhibitors or new oral anticoagulants (NOAC)during the last 48 hours unless reversal of effect can be achieved with a reversalagent (by idarucizumab) or sensitivity laboratory test values greater than the upperlimit of normal (eg, activated partial thromboplastin time (aPTT), internationalnormalized ratio (INR), platelet count, thrombin time (TT), or appropriate factor Xaactivity assay); if on any full dose heparin/heparinoid during the last 24 hours orwith an elevated aPTT greater than the upper limit of normal;

9. Known defect of platelet function or platelet count below 100,000/mm3 (but patientson antiplatelet agents can be included);

10. Ischemic stroke or myocardial infarction in previous 3 months, previous intracranialhaemorrhage, severe traumatic brain injury or intracranial or intraspinal operationin previous 3 months, or known intracranial neoplasm (except for neuroectodermaltumors, such as meningiomas), arteriovenous malformation or giant aneurysm;

11. Any terminal illness such that patient would not be expected to survive more than 1year

12. Large cerebral infarction (infarct size > 1/3 MCA territory) on CT or MRI;

13. Acute or past intracerebral hemorrhage (ICH) identified by CT or MRI (includingintraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage,subdural/epidural hematoma);

14. Pregnant women, nursing mothers, or reluctant to agree taking effectivecontraceptive measures during the period of trial subjects;

15. 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;

16. Participation in other interventional clinical trials within the previous 3 months.