Safety and Efficacy of Intra-arterial Tenecteplase for Noncomplete Reperfusion of Intracranial Occlusions

Inclusion Criteria * Informed consent * Age ≥18 years * Clinical signs consistent with an acute ischemic stroke * Patient had an initial vessel occlusion in the anterior or posterior circulation defined as intracranial ICA, M1, M2, M3, A1, A2, P1 or P2 * Patient has undergone endovascular stroke treatment * Onset to randomization no later than \< 705 minutes (11h 45min) after symptom-onset/last-seen well. * Incomplete reperfusion defined as any of the following: 1. For ICA/M1: TICI2b/2c (50-99%) reperfusion after endovascular treatment without mechanically amendable target-occlusion (as per definition by the interventionalist). 2. For A1/A2, P1/P2, M2/M3: TICI2a/2b/2c (1-99%) reperfusion after endovascular treatment without mechanically amendable target-occlusion (as per definition by the interventionalist). 3. Any emboli to new territory without mechanically amendable target-occlusion (as per definition by the interventionalist). * Signs of early ischemic changes of non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS) ≥5 (for DWI-ASPECTS ≥ 4, for DWI-ASECTS: a region must have diffusion abnormality in 20% or more of its volume to be considered DWI-ASPECTS positive) Exclusion Criteria * Acute intracranial hemorrhage * Contraindication to MRI (e.g. pacemaker) * Any severe bleeding within the past 6 months, which would prevent administration of intravenous thrombolysis in clinical routine Major surgery in the past 2 months with severe risk of bleeding, which would prevent administration of intravenous thrombolysis in clinical routine * Intake of Vitamin K antagonists with INR \>1.7 * Platelets \< 50,000 * Non-controlled hypertension (defined as SBP \>185 mmHg or DBP \>110 mmHg refractory to treatment) * Active dyspeptic ulcer * Known arterial aneurysm * Known neoplasms with risk of bleeding * Severe liver fibrosis or portal hypertension * Acute pericarditis * Acute endocarditis * Acute pancreatitis * Known allergy to TNK or Gentamicin or other additives/auxiliaries (Polysorbatum 20, L-Argininum, Acidum phosphoricum) * Known Renal failure either as defined by a serum creatinine \> 3.0 mg/dl (or 265.2 μmol/l) or glomerular Filtration Rate \[GFR\] \< 30 or as subject who required hemodialysis/peritoneal dialysis * Radiological confirmed evidence of mass effect or intracranial tumor (except small meningioma) * Radiological confirmed evidence of cerebral vasculitis * Calcified thrombi * Pregnancy or lactating women