Intra-arterial Recombinant Human Tenecteplase Tissue-type Plasminogen Activator (rhTNK-tPA) Thrombolysis for Acute Medium Vessel Occlusion

Inclusion Criteria: 1. Age ≥18 years 2. Pre-stroke mRS score 0-1 3. Baseline NIHSS ≥4 or symptoms deemed clearly disabling by treating physician (e.g., hemianopia, aphasia, or motor dysfunction) 4. Isolated medium distal vessel occlusion (i.e., an occlusion of the co-/non-dominant M2, the M3/M4 segment of the MCA, the A1/A2/A3 segment of the ACA or the P1/P2/P3 segment of the PCA) confirmed by CT angiography (CTA) or MR angiography (MRA) 5. Acute ischemic stroke within 24 hours of symptom onset, including wake-up stroke or unwitnessed stroke; The onset time of symptoms was defined as the last time of normal performance. 6. Acute ischemic stroke within 6-24 hours of onset, meeting at least one of the following imaging criteria: 1. Evidence of a hypoperfusion-ischemic core mismatch on CT or MRI perfusion, defined as an ischemic core volume \<50mL, hypoperfused tissue volume to ischemic core volume ratio ≥1.2, and mismatch volume ≥10 mL 2. Evidence of a diffusion-hyperintensity mismatch, defined as absence of hyperintensity on fluidattenuated inversion recovery (FLAIR) imaging within ≥ 90% of the area of the diffusion weighted imaging (DWI) lesion) 7. The participant or legally authorized representative is capable of providing informed consent Exclusion Criteria: 1. Evidence of intracranial hemorrhage 2. Any active bleeding (gastrointestinal, urinary, hemorrhagic retinopathy, etc.) or parenchymal organ surgery or biopsy within 30 days before stroke; Severe head trauma or stroke within the past 3 months 3. Persistent and uncontrolled hypertension, defined as systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg 4. Inherited or acquired hemorrhagic tendancy; deficiency of anticoagulant factors; or on oral anticoagulant with an INR\> 1.7 5. Blood glucose \<2.8 mmol/L (50 mg/dl) or \> 22.2mmol/L (400 mg/dl), platelets count \<100\*109/L, or hemoglobin \<70g/L 6. Severe hepatic insufficiency, chronic hemodialysis and severe renal insufficiency (or recent blood tests suggesting a glomerular filtration rate \<30 ml/min or blood creatinine\> 200 mmol/L (2.5 mg/dl) 7. Women who are pregnant or breastfeeding 8. Allergy to rhTNK-tPA or radiocontrast agent 9. Participation in other clinical trials 10. Expected survival time less than 6 months (e.g., due to malignancy, severe cardiopulmonary disease, etc.) 11. Other conditions deemed by the investigator to make the patient unsuitable for participation or pose significant risks (e.g., inability to understand and/or comply with study procedures and/or follow-up due to mental illness, cognitive or emotional disorders)