Phase III Clinical Trial of rhTNK-tPA in Treating Acute Ischemic Stroke With Extended Time Window.

Inclusion Criteria: 1. Aged ≥ 18 years, regardless of gender; 2. Time from symptom onset to treatment is 4.5 - 24 hours(Including the boundary values.), including patients with wake-up stroke or stroke without witnesses; the time of symptom onset is defined as the "last known normal time"; 3. Modified Rankin Scale (mRS) score ≤ 1 before stroke onset; 4. Baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 6; 5. Neuroimaging findings: occlusion of the internal carotid artery (ICA), M1 or M2 segment of the middle cerebral artery (MCA) confirmed by computed tomography angiography (CTA)/magnetic resonance angiography (MRA), which is the responsible vessel for the signs and symptoms of acute ischemic stroke; presence of target mismatch on computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) + magnetic resonance perfusion (MRP) (ischemic core volume \< 70 mL, mismatch ratio ≥ 1.8, mismatch volume ≥ 15 mL); 6. Voluntary signing of the informed consent form by the participant or their legal guardian. Exclusion Criteria: 1. Patients with known allergy to recombinant human tissue plasminogen activator (rhTNK-tPA); 2. Patients with an expected life expectancy of less than 1 year; 3. Patients with rapidly improving symptoms (which may indicate spontaneous recanalization), as determined by the investigator; 4. Patients with a score of \> 2 on Item 1a (Level of Consciousness) of the National Institutes of Health Stroke Scale (NIHSS), or those who had a seizure at stroke onset, or had hemiplegia after seizure, or had other neurological/psychiatric disorders that rendered them unable or unwilling to cooperate; 5. Severe and persistent hypertension uncontrolled by medication ; 6. Blood glucose \< 2.8 mmol/L or \> 22.2 mmol/L; 7. Active internal bleeding with a high risk of hemorrhage; 8. Any known coagulation disorder; 9. Known platelet function defect or platelet count less than 100×10⁹/L;