Efficacy and Safety of Intra-arterial Tenecteplase in Acute Ischemic Stroke Patients With Medium Vessel Occlusion Stroke (DATE-MeVO)

Inclusion Criteria: 1. Age ≥18 years old 2. Acute isolated intracranial medium vessel occlusion (Distal middle cerebral artery M2; M3 and M4 segments of the middle cerebral artery; A1-A4 segments of the anterior cerebral artery; P1-P3 segments of the posterior cerebral artery), confirmed by imaging, with symptom onset to randomization within 24 hours; 3. NlHSS score ≥ 5 4. CT scan performed within 24 hours confirming that the ischemic lesion does not involve more than one-third of the territory supplied by the responsible vessel (no evidence of early large infarction) 5. Patients with premorbid mRS 0 or 1 6. Written informed consent obtained from the participant or a legally authorized representative Exclusion Criteria: 1. Intracranial hemorrhage confirmed by cranial CT or MRI; 2. Already received intravenous thrombolysis; 3. Planned mechanical thrombectomy; 4. Intraoperative DSA showing vessel rupture, dissection, or contrast agent extravasation; 5. Pregnant or breastfeeding women; 6. Allergy to contrast agents or tenecteplase; 7. Systolic blood pressure \> 185 mmHg or diastolic blood pressure \> 110 mmHg, and failure to control with oral antihypertensive medications; 8. Genetic or acquired bleeding disorders, coagulation factor deficiencies; coagulation dysfunction, INR \> 1.7, or use of novel oral anticoagulants within 48 hours; 9. Blood glucose \< 2.8 mmol/L (50 mg/dL) or \> 22.2 mmol/L (400 mg/dL), platelet count \< 100 × 10\^9/L; 10. History of bleeding within the past month (gastrointestinal or urinary tract bleeding); 11. Chronic hemodialysis or severe renal insufficiency (glomerular filtration rate \< 30 mL/min or serum creatinine \> 220 μmol/L (2.5 mg/dL)); 12. Severe mental disorders or inability to provide informed consent and comply with follow-up due to dementia; 13. Concurrent malignant tumors or severe systemic diseases with an expected survival time of less than 90 days; 14. Intracranial aneurysms or arteriovenous malformations; 15. Participation in another clinical interventional trial within 30 days prior to randomization or currently participating in another clinical interventional trial; 16. Occlusions in multiple vascular territories confirmed by CTA/MRA; 17. Other reasons that the investigator deems inappropriate for participation in the trial