Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 18.0-80.0,  Stroke To be eligible for entry into this study, candidates must meet all of the following at the time of Emergency Department presentation: 1. Age: 18-80 years old 2. Ischemic Wake Up Stroke (Unknown time of onset but less than 24 hours since last seen normal) 3. National Institute of Health Stroke Scale (NIHSS) 8-22 4. Evidence of penumbra on Computed Tomography Perfusion(CTP) as mentioned above 5. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS 7 or more) 6. Signed informed consent  Potential study patients will be excluded from study entry if any of the following exist at the time of screening: 1. Evidence of intracranial hemorrhage (Intracerebral hematoma, intraventricular hemorrhage, subarachnoid hemorrhage (SAH), epidural hemorrhage, acute or chronic subdural hematoma (SDH)) on the baseline CT 2. Historical Modified Rankin Scale (mRS) of ≥2 3. National Institute of Health Stroke Scale (NIHSS)<8 at the time of treatment 4. Positive pregnancy test in women at age of childbearing 5. Intracranial or intraspinal surgery within 3 months 6. Stroke or serious head injury within 3 months 7. History of intracranial hemorrhage 8. Uncontrolled hypertension at time of treatment (eg, >185 mm Hg systolic or >110 mm Hg diastolic) 9. Seizure at the onset of stroke 10. Active internal bleeding 11. Intracranial neoplasm 12. Arteriovenous malformation or aneurysm 13. Clinical presentation suggesting post-MI pericarditis 14. Known bleeding diathesis including but not limited to current use of oral anticoagulants producing an Internation normalized ratio (INR) >1.7 15. Internation normalized ratio (INR) >1.7 16. Administration of heparin within 48 hours preceding the onset of stroke with an elevated activated Partial Thromboplastin Time(aPTT) at presentation 17. Platelet count <100,000/mm 18. Major surgery within 2 weeks 19. GastroIntestinal (GI) or urinary tract hemorrhage within 3 weeks 20. Aggressive treatment required to lower blood pressure 21. Glucose level <50 or >400 mg/dL 22. Arterial puncture at a noncompressible site or lumbar puncture within 1 week