This study focuses on Acute Ischemic Stroke, a condition that occurs when a blood vessel supplying the brain becomes blocked, preventing oxygen from reaching brain cells. The research aims to evaluate the effectiveness and safety of tenecteplase compared to the current standard medical treatments. This study is specifically looking at individuals who were last seen well more than 4.5 hours before receiving treatment, including cases known as wake-up stroke, where the exact time the symptoms started is unknown. This group includes people who show evidence through imaging, such as a computed tomography scan, that there is still salvageable brain tissue that can be saved if blood flow is restored.

During the trial, participants will receive either tenecteplase or the standard of care via an intravenous bolus, which is a method of delivering medication directly into a vein in a single quick dose. The study will monitor how well patients recover and function over a period of time, specifically looking at their ability to perform daily activities 90 days after the event. The researchers will also observe for any potential side effects, such as symptomatic intracranial hemorrhage, which is a type of bleeding inside the brain that can occur following treatment.