Adjunctive Intra-arterial Tenecteplase Following Mechanical Thrombectomy Pilot Trial

Inclusion 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\. a. Patients treated less than 6 hours since last known well with ASPECTS \>6. b. Patients treated beyond 6 hours since last known well, CT or MRI perfusion scan showing favorable mismatch profile (Target mismatch profile on CT perfusion or MRI (ischemic core volume is \<70ml, mismatch ratio is \>1.8 and mismatch volume is \>15ml) * 4\. Post-mechanical thrombectomy with ≤5 device passes and mTICI grade 2b or 2c with persistent occlusion(s) in terminal branches not amenable to MT. * 5\. Signed informed consent Exclusion Criteria: * 1\. Premorbid modified Rankin scale (mRS) score of 4 or greater * 2\. Presence of any hemorrhage and/or ASPECT score ≤6 on baseline head CT * 3\. Platelet count \<100,000 * 4\. Known bleeding diathesis * 5\. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency * 6\. Active anticoagulation treatment with novel oral anticoagulant (NOACs) taken within the last 48 hours, or INR \>1.8 * 7\. Patients requiring active treatment with dual antiplatelet agents (e.g. proximal cervical carotid artery stenting) * 8\. Pregnant or lactating * 9\. Previous known allergy to TNK * 10\. Major surgery in past 30 days * 11\. Patient is on or requires dialysis * 12\. History of intracranial hemorrhage or serious head trauma at any time * 13\. Any condition in the opinion of the enrolling physician that would preclude the patient from participating * 14\. Pre-existing medical, neurological, or psychiatric disease that would confound the neurological or functional evaluation * 15\. Severe, uncontrolled hypertension (systolic blood pressure \>180 mmHg or diastolic blood pressure \>110 mmHg) that is refractory to treatment * 16\. History of acute ischemic stroke in the last 60 days * 17\. Presumed septic embolus; suspicion of bacterial endocarditis * 18\. Suspicion of aortic dissection * 19\. Intracranial neoplasm * 20\. Any mass effect * 21\. Any terminal medical condition with life expectancy less than 6 months * 22\. Concurrent enrollment in another trial that could confound the results of this study