Teneteplase Reperfusion Therapy in Acute Ischemic Cerebrovascular Events-Ⅳ

Inclusion Criteria

1. Age ≥ 18 years;

2. Onset-to-treatment time < 4.5 h; onset time defined as "last known well" time;

3. Clinical diagnosis of minor ischemic stroke (NIHSS ≤ 5) with persistent unilateral limb weakness or speech symptoms, defined as a score of ≥1 on either the language item or a single limb item of the NIHSS;

4. Pre-stroke mRS 0-1;

5. Informed consent signed.

Exclusion Criteria

1. Planned or likely acute endovascular treatments before randomization;

2. NIHSS 1a > 2;

3. Known allergic to rhTNK-tPA;

4. History of intracranial hemorrhage;

5. Severe head trauma or previous stroke within 3 months；

6. Intracranial or spinal surgery within 3 months;

7. Gastrointestinal or urinary tract hemorrhage within 3 weeks；

8. Major surgery within 2 weeks;

9. Arterial puncture at a non-compressible site within 1 week；

10. Intracranial tumors (excluding neuroectodermal tumors, e.g., meningiomas), large intracranial aneurysms, or arteriovenous malformations；

11. Intracranial hemorrhage, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and subdural/epidural hematoma;

12. Active visceral bleeding;

13. Concomitantaortic arch dissection;

14. Acute bleeding tendency, including platelet count <100×10⁹/L or other clinically significant conditions;

15. Uncontrolled hypertension after active antihypertensive treatment: systolic blood pressure >180 mm Hg or diastolic >100 mm Hg;

16. Blood glucose < 2.8 or > 22.2 mmol / L;

17. Prior anticoagulant therapy, such as oral warfarin, with an INR >1.7 or PT >15 seconds;

18. Use of heparin within 24 hours;

19. Use of thrombin inhibitors or factor Xa inhibitors within 48 hours;

20. Large cerebral infarction on head CT or MRI (infarction area >1/3 of the middle cerebral artery territory);

21. Todd's paralysis after a seizure or other neurological/psychiatric disorders affecting cooperation;

22. Severe, uncontrolled infections (e.g., acute pericarditis, infective endocarditis, or acute pancreatitis);

23. Pregnant or breastfeeding women, or women unwilling to use effective contraception during the study period;

24. Participation in another clinical trial within 3 months prior to screening;

25. Other severe illnesses with a life expectancy of less than six months;

26. Deemed unsuitable for the study or at increased risk by the investigator's judgment.