Upon joining the study, informed consent is required. This means understanding the study’s purpose, procedures, and potential risks and benefits before agreeing to participate.

Eligibility criteria include being at least 18 years old and experiencing clinical signs consistent with an acute ischemic stroke.

An initial assessment will be conducted to confirm the presence of a large vessel blockage in the brain’s anterior circulation. This includes specific areas such as the intracranial ICA, M1, M2, M3, A1, A2, P1, or P2.

The assessment will also confirm that the patient has undergone a procedure called endovascular stroke treatment.

Randomization will occur within 705 minutes (11 hours and 45 minutes) after the onset of stroke symptoms or the last time the patient was known to be well.

This step involves being randomly assigned to receive the study treatment or a standard treatment.

The study treatment involves the administration of tenecteplase, a medication given through intra-arterial use. This means it is delivered directly into the artery.

The medication is provided as a solution for injection, specifically Metalyse 10,000 units.

After treatment, monitoring will occur to assess early and late reperfusion, which refers to the restoration of blood flow in the brain.

Follow-up assessments will be conducted to evaluate the degree of disability or dependence at approximately 90 days, using a scale called the mRS.

Additional evaluations include changes in the NIHSS, a scale that measures stroke severity, at 24 hours and 90 days post-randomization.

Quality of life will be assessed using the EuroQol 5D-3L questionnaire at 90 days, and all-cause mortality will be recorded at 90 days.