OPtimizing REperfusion by Intra-Arterial ThRomboLysis as Adjunct to Endovascular Treatment for Medium Vessel Occlusion

Exclusion Criteria18

• Evidence of intracranial hemorrhage.
• Pre-stroke mRS score ≥ 2.
• Rapidly improving symptoms, in the judgment of the managing clinician that the improvement is likely to result in the patient having an NIHSS score of <6 at randomization.
• The intervention procedure is unlikely to be completed as assessed by the investigator.
• Suspected cerebral vasculitis, septic embolization, or vascular occlusion due to infective endocarditis.
• Suspected arterial dissection.
• Severe allergy to contrast agents (non-mild rash allergy) or absolute contraindication to iodine contrast.
• Known genetic or acquired bleeding disposition or anticoagulant factors deficiency.
• Coagulation disorder with INR >1.7 or use of new oral anticoagulants within 48 hours prior to symptom onset.
• Platelet count <50×10\^9/L.
• Any active or recent bleeding (gastrointestinal, urinary tract bleeding, etc.), or previous parenchymal organ surgery or biopsy in the last 1 month.
• Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, refractory to treatment.
• Known severe renal insufficiency with glomerular filtration rate <30 ml/min or blood creatinine >220 μmol/L (2.5 mg/dl).
• Radiological confirmed evidence of mass effect or intracranial tumour (except small meningioma).
• Anticipated life expectancy <6 months due to advanced disease (e.g., malignancy, severe cardiopulmonary disease, etc.).
• Women who are pregnant or breastfeeding.
• Participation in other clinical trials.
• Any condition that, in the judgment of the investigator, makes the patient unsuitable for this study or where this study may impose a significant risk to the patient (e.g., inability to understand and/or comply with study procedures and/or follow-up due to psychiatric disorders, cognitive or emotional impairment).