Dual Thrombolytic Therapy With Mutant Pro-urokinase and Low Dose Alteplase for Ischemic Stroke

Inclusion Criteria: * A clinical diagnosis of ischemic stroke; * A score of at least 1 on the NIH Stroke Scale; * CT ruling out intracranial hemorrhage; * Treatment possible within 4.5 hours from symptom onset or last seen well; * Meet the criteria for standard treatment for IV alteplase according to national guidelines27; * Age of 18 years or older; * Written informed consent (deferred). Exclusion Criteria: * Candidate for endovascular thrombectomy (i.e., a proximal intracranial large artery occlusion on CTA); * Contra-indication for treatment with IV alteplase according to national guidelines27: * Arterial blood pressure exceeding 185/110 mmHg and not responding to treatment * Blood glucose less than 2.7 or over 22.2 mmol/L * Cerebral infarction in the previous 6 weeks with residual neurological deficit or signs of recent infarction on neuro-imaging * Head trauma in the previous 4 weeks * Major surgery or serious trauma in the previous 2 weeks * Gastrointestinal or urinary tract hemorrhage in the previous 2 weeks * Previous intracerebral hemorrhage * Use of anticoagulant with INR exceeding 1.7 or APTT exceeding 50 seconds * Known thrombocyte count less than 90 x 109 /L * Treatment with direct thrombin or factor X inhibitors, unless specific antidotum has been given, i.e. idarucizumab in case of dabigatran use. * Pre-stroke disability which interferes with the assessment of functional outcome at 90 days, i.e. mRS \> 2; * Known pregnancy or if pregnancy cannot be excluded, i.e. did not have intercourse for \> 6 months and no clinical signs of pregnancy, adequate use of any contraceptive method (e.g. intrauterine devices) or sterilization of the subject herself. * Contra-indication for an MRI scan, i.e.: * an MRI incompatible pacemaker, ICD, pacing wires and loop records * metallic foreign bodies (e.g. intra-ocular) * prosthetic heart valves * blood vessel clips, coils or stents * an implanted electronic and/or magnetic implant or pump (e.g. neurostimulator) * cochlear implants * mechanical implants (implanted less than 6 weeks ago) * a copper intrauterine device * Current Participation in any medical or surgical therapeutic trial other than DUMAS.