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): 20.0-999.0,  Cerebral Infarction Brain Ischemia Patients with acute ischemic stroke within 3 hours of onset, with a clearly defined time of onset  patients with rapidly improving neurological symptoms or with minor neurological deficit (National Institutes of Health Stroke Scale (NIHSS) score of ≤4) prior to the start of treatment 2. Computed Tomography (CT) evidence of non-minor early ischemic signs (minor early ischemic sign was defined as the involvement of one-third or less of the middle cerebral artery area) 3. CT evidence of cerebral hemorrhage or subarachnoid hemorrhage 4. symptoms suggestive of subarachnoid hemorrhage 5. lactation, pregnancy or suggestive pregnancy; menstruation 6. platelet count below 100,000/mm3 7. heparin administration within 48 hours preceding stroke onset with an elevated activated partial thromboplastin time (APTT); current use of oral anticoagulants with an International Normalized Ratio (INR) of ≥1.7; use of drugs not allowed to be administered concomitantly with alteplase (other thrombolytic agents, ozagrel sodium, argatroban and edaravone) prior to the study treatment 8. major surgery or serious trauma within the preceding 14 days; serious head or spinal cord trauma within the preceding 3 months 9. a history of gastrointestinal or urinary tract hemorrhage within the previous 21 days 10. arterial puncture at a noncompressible site within the preceding 7 days 11. a history of stroke within the preceding 3 months; a history of intracranial hemorrhage or increased risk of intracranial hemorrhage because of cerebral aneurysm, arteriovenous malformation, neoplasm, etc. 12. concurrent severe hepatic or renal dysfunction 13. malignant tumor under treatment 14. a systolic blood pressure of >185 mmHg or diastolic blood pressure of >110 mmHg 15. a need for aggressive treatment to reduce blood pressure to below these limits(14)) 16. blood glucose levels of <50 mg/dL or >400 mg/dL 17. acute myocardial infarction(AMI) or endocarditis after AMI 18. concurrent infectious endocarditis, moya-moya disease (Willis circle occlusion syndrome), aortic dissection, neck trauma, etc.; strong suspicion of ischemic cerebrovascular disorder caused by non-thrombotic occlusion or any other hemodynamic condition 19. seizure at the onset of stroke 20. coma (a Japan Coma Scale score of ≥100) 21. an mRS score of ≥2 before stroke onset 22. a history of hypersensitivity to protein preparations 23. difficulty in monitoring for 3 months 24. less than 3 months since any other clinical trial