Adjunctive Intra-arterial Tenecteplase Following Mechanical Thrombectomy (ALLY) II Trial

Eligibility Criteria

• 1. Age 18-85
• 2. Anterior circulation ischemic stroke symptoms with confirmed occlusion (ICA, M1, or M2) on angiogram and mechanical thrombectomy initiated within 24 hours since last known well
• 3. Alberta Stroke Program Early CT Score (ASPECTS) Score ≥6 on baseline Non-contrast Head CT (NCCT)
• 4. Post-mechanical thrombectomy with ≤5 device passes and mTICI grade 2b or higher.
• 5. Ability to obtain signed informed consent prior to randomization from LAR or Subject
• 1. Premorbid modified Rankin scale (mRS) score \>1
• 2. Imaging evidence of hemorrhage or mass effect at baseline
• 3. Platelet count \<100,000
• 4. Active hemorrhagic diathesis, or known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency
• 5. Active anticoagulation treatment with novel oral anticoagulant (NOACs) taken within the last 48 hours, or INR \>1.7
• 6. Patients requiring active treatment with dual antiplatelet agents (e.g. proximal cervical carotid artery stenting)
• 7. Pregnant or lactating
• 8. Previous known allergy to TNK
• 9. Major surgery in past 30 days
• 10. Patient is on or requires dialysis
• 11. History of intracranial hemorrhage or serious head trauma at any time
• 12. Any condition in the opinion of the enrolling physician that would preclude the patient from participating
• 13. Pre-existing medical, neurological, or psychiatric disease that would confound the neurological or functional evaluation
• 14. Severe, uncontrolled hypertension (systolic blood pressure \>180 mmHg or diastolic blood pressure \>110 mmHg) that is refractory to treatment
• 15. History of acute ischemic stroke in the last 60 days and/or has received previous treatment with a thrombolytic within the last 90 days
• 16. Presumed septic embolus; suspicion of bacterial endocarditis
• 17. Suspicion of aortic dissection
• 18. Intracranial neoplasm
• 19. Any terminal medical condition with life expectancy less than 6 months
• 20. Concurrent enrollment in another trial that could confound the results of this study
• 21. Patient is unlikely to return for 90-day follow-up.
• 22. Intravenous tissue plasminogen activator (tPA) administered concurrently with Intra-arterial TNK