Intravenous Recombinant Human Prourokinase for Acute Medium Vessel Occlusion 4.5-24 Hours After Ischemic Stroke

You may not qualify if:

• Patients who have received reperfusion therapy, including intravenous thrombolysis, intra-arterial thrombolysis, or endovascular therapy (EVT), within 72 hours after the onset of the current stroke and before randomization..
• Patients with a clear treatment plan established before randomization that includes intravenous thrombolysis.
• Planned EVT or intra-arterial thrombolysis.
• Known history of severe hypersensitivity to recombinant human prourokinase, human albumin, mannitol, iodinated contrast media, or medications used for study-related examinations or treatment.
• Rapidly improving clinical symptoms such that, in the investigator's judgment, the participant is not suitable for the study intervention.
• Seizure at stroke onset when, in the investigator's judgment, the neurological deficit may be attributable to postictal Todd paralysis or another non-ischemic cause.
• Other severe neurological, psychiatric, or systemic disease that may substantially affect efficacy assessment, compliance, or completion of follow-up.
• Persistent severe hypertension that cannot be adequately controlled with medication, defined as systolic blood pressure ≥185 mmHg or diastolic blood pressure ≥110 mmHg before treatment and remaining uncontrolled after antihypertensive treatment.
• Blood glucose \<2.8 mmol/L or \>22.2 mmol/L and, after appropriate treatment, the participant remains unsuitable for enrollment.
• Active internal bleeding or a condition associated with a high risk of bleeding, including but not limited to gastrointestinal or urinary tract bleeding within the previous 21 days; major surgery, severe trauma, or biopsy of a major organ within the previous 21 days; arterial puncture at a noncompressible site within the previous 7 days; or any other condition considered by the investigator to confer a substantial bleeding risk.
• Known coagulation abnormality or bleeding tendency, including but not limited to platelet count \<100 × 10\^9/L, international normalized ratio (INR) \>1.7, markedly prolonged prothrombin time (PT), activated partial thromboplastin time (APTT) above the upper limit of normal and considered clinically significant, or markedly reduced fibrinogen level.
• Current or recent use of anticoagulant therapy associated with an increased thrombolysis-related bleeding risk, including use of a vitamin K antagonist with INR \>1.7; use of a direct thrombin inhibitor or factor Xa inhibitor within the previous 48 hours with abnormal relevant coagulation tests; or use of heparin within the previous 24 hours with APTT above the upper limit of normal.
• History of ischemic stroke, severe head trauma, or myocardial infarction within the previous 3 months.
• History of intracranial hemorrhage.
• Intracranial or intraspinal surgery within the previous 3 months.
• +12 more criteria