Intravenous Thrombolysis With rhTNK-tPA for Acute Non-large Vessel Occlusion in Extended Time Window

Inclusion Criteria: * Clinical diagnosis of acute ischemic stroke * Age≥18 years * Pre-stroke mRS score≤1 points * Disabling stroke defined as follows: * Baseline NIHSS score 6-25 at the time of randomization, * Or NIHSS 4-5 with disabling deficit (e.g. hemianopia, aphasia, loss of hand function) as determined by the managing clinician * Onset (last-seen-well) time to treatment time between 4.5 and 24 hours * Written informed consent from patients or legally responsible representatives * The presence of a Target Mismatch on CT perfusion: ischemic core volume\<50ml (defined as rCBF\<30%), mismatch ratio≥1.2 (Tmax\>6 sec lesion/core volume lesion), mismatch volume≥10ml Exclusion Criteria: * Treatment with a thrombolytic within the last 72 hours or intention to receive intravenous thrombolysis * Contraindication to thrombolysis * Planned or anticipated treatment with endovascular therapy * Rapidly improving symptoms, particularly if in the judgment of the managing clinician that the improvement is likely to result in a NIHSS score\<4 at randomization * Pregnancy or lactating; formal testing needed in women of childbearing potential * Brain tumor (with mass effect) * Hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency * Impairment in coagulation due to comorbid disease or anticoagulant use. If on warfarin, international normalized ratio (INR) \>1.7 or prothrombin time \>15s; if use of any direct oral anticoagulant within the last 48 hours; if use o…