{
  "abstract": "Background The TRACE III trial showed that for patients with large arterial occlusion presenting 4.5–24 hours of symptom occurrence and a salvageable penumbra on perfusion imaging, intravenous tenecteplase (TNK) thrombolysis is safe and can significantly improve patient outcomes in cases where endovascular thrombectomy is not feasible. However, it is currently unknown whether intravenous TNK thrombolysis beyond 4.5 hours can improve the outcomes of subjects with distal medium vessel occlusion (MeVO).Objective To determine the safety and effectiveness of extended window TNK thrombolysis for MeVO stroke.Methods and design Extending the Time Window for Intravenous TNK in Patients with Distal Medium Vessel Occlusions Stroke (TNK-MeVO) is a prospective, randomised, controlled, multicentre and open-label study with blinded outcome assessment. Up to 560 eligible subjects will be randomised 1:1 to receive TNK thrombolysis or standard medical management in over 40 comprehensive stroke centres across China.Outcomes The primary endpoint is the rates of modified Rankin Scale score of 0–1 at 90 days. Safety endpoints include symptomatic intracerebral haemorrhage within 24 hours and mortality at 90 days.Conclusions TNK-MeVO trial is designed to provide robust evidence on whether TNK thrombolysis is safe and effective for acute MeVO stroke presenting 4.5–24 hours of symptom onset.Trial registration number NCT06559436.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Xiaozhong Jing"
    },
    {
      "affiliations": [
        "The UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Raul G Nogueira"
    },
    {
      "affiliations": [
        "Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA",
        "Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Thanh Nguyen"
    },
    {
      "affiliations": [
        "Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA",
        "Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Mohamad Abdalkader"
    },
    {
      "affiliations": [
        "The UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Abdullah M Al-Qudah"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Chunrong Tao"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Rui Li"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Jun Sun"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Yuyou Zhu"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Li Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Zhang Chao"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Tianlong Liu"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Jianlong Song"
    },
    {
      "affiliations": [
        "Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA"
      ],
      "name": "Jeffrey L Saver"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Wei Hu"
    }
  ],
  "title": "Extending the time window for intravenous tenecteplase in patients with distal medium vessel occlusions stroke: study protocol and rationale",
  "uid": "03027b0c-d3f5-5acb-8218-c8da0de0e8ae"
}