The benefit of intravenous tenecteplase in very old patients with acute ischemic stroke (AIS) remain uncertain. This real-world study aims to evaluate the effectiveness and safety of intravenous tenecteplase in AIS patients aged 80 years or older within 4.5 hours of symptom onset.

The study is an investigator-initiated, multicenter, prospective, observational, real-world registry designed to evaluate the effectiveness and safety of intravenous tenecteplase in AIS patients aged 80 years or older within 4.5 hours of symptom onset. The primary outcome is excellent outcome, as defined by a score of 0 or 1 on modified Rankin Scale (mRS) at 90 days. The study is anticipated to enroll at least 392 participants, with no less than 196 participants in the tenecteplase group.

Inclusion Criteria:

1. Age > 80 years;
2. Clinically diagnosed with acute ischemic stroke and arrived at the hospital within 4.5 hours of symptom onset;
3. Informed consent signed by the patient or legally authorized representative.

Exclusion Criteria:

1. Any contraindication to intravenous thrombolysis (excluding age);
2. Previous treatment with other thrombolytic agents such as alteplase, urokinase, plasminogen activator, or reteplase;
3. Current participation in other interventional studies;
4. The investigator deems the patient unsuitable for this study or the study might pose significant risk to the patient (e.g., due to psychiatric disorders, cognitive or emotional impairments that prevent understanding or adherence to study procedures and/or follow-up).

This study will consecutively screen patients with acute ischemic stroke (AIS) who are over 80 years of age and arrive at the hospital within 4.5 hours of symptom onset.

Data supporting the findings of the study are available on reasonable request after approval of a proposal from the principal investigator.