TNK-tPA Evaluation for Minor Ischemic Stroke With Proven Occlusion

Inclusion Criteria: 1. Acute ischemic stroke in an adult patient (18 years of age or older) 2. Onset (last-seen-well) time to treatment time \< 12 hours. 3. Minor stroke defined as a baseline NIHSS \< 6 at the time of randomization. Patients must have a demonstrable neurological deficit on physical neurological examination. 4. Any acute intracranial occlusion (MCA, ACA, PCA, VB territories) defined by non-invasive acute imaging (CT angiography) that is neurologically relevant to the presenting symptoms and signs. An acute occlusion is defined as TICI 0 or TICI 1 flow. 5. Pre-stroke independent functional status in activities of daily living with pre-stroke estimated modified Barthel Index of 90 or greater AND premorbid mRS 0 or 1. 6. Informed consent from the patient or surrogate. 7. Patients can be treated within 90 minutes of the CT/CTA being completed. Exclusion Criteria: 1. Hyperdensity on NCCT consistent with any intracranial hemorrhage. Any clinical suspicion of any intracranial hemorrhage even in the absence of visible blood on baseline brain imaging. 2. Large acute stroke \>1/3 MCA territory or ASPECTS\<5 visible on baseline CT scan. 3. Core of established infarction. No area of grey matter hypodensity at a similar or lesser density to white matter or in the judgment of the enrolling neurologist is consistent with a subacute ischemic stroke \> 12 hours of age. 4. Clinical history, past imaging and clinical judgment suggest that the intracranial occlusion is chronic. 5. Patient is a candidate for and should receive standard of care IV tPA. 6. Stroke occurring as an in-patient. An in-patient is a person who has been officially admitted to the hospital to a ward bed. A patient in the ED who has not been formally admitted is still considered to be an outpatient. 7. Patient has a severe or fatal or disabling illness that will prevent improvement or follow-up or such that the treatment would not likely benefit the patient. 8. Patient cannot complete follow-up due to co-morbid non-fatal illness or is visiting the host sites city and cannot return for follow-up. 9. Pregnancy. 10. Patient is actively taking dual antiplatelet medication (aspirin \& clopidogrel) in the last 48 hours. 11. International normalized ratio \> 1.4 12. Standard thrombolysis exclusions (Taken from Canadian guidelines1) NOTES: NIHSS = National Institutes of Health Stroke Scale ACA = anterior cerebral artery MCA = middle cerebral artery ICA = internal cerebral artery PCA = posterior cerebral artery VB = vertebrobasilar TICI = thrombolysis in cerebral ischemic scale CT = computed tomography NCCT = non-contrast CT CTA = CT angiography ASPECTS = Alberta Stroke Program Early CT Score IV = intravenous tPA = tissue plasminogen activator ED = Emergency Department