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): 18.0-999.0,  Stroke Cerebral Ischemia Disabling Ischemic stroke symptoms with onset < 3 hours treated with IV rt-PA by local standards* or </= 4.5 hours according to local standard of care. Symptoms must be distinguished from another ischemic event such as syncope, seizure, migraine, subarachnoid hemorrhage and hypoglycemia. If the patient reports awakening with the event, the time of onset should be considered as the last time the patient (or a witness to the patient's condition) considered herself/himself normal Patients should meet local, institutional to undergo emergent Endovascular Therapy (Intra-Arterial) to 1. IAT must be able to begin before 6-hours of stroke onset or last seen well. 2. CT-Angiogram confirmation of intra-arterial occlusion in any of the following locations: terminal ICA, MCA (M1 or M2 territories), PCA, distal vertebral or basilar artery. 3. score on non-contrast head CT must be >/= 6. 4. IAT must be able to begin within 90 minutes of qualifying CT scan Age >/= 18 Females of childbearing potential must have a negative pregnancy test prior to the administration of trial medication Signed (written) informed consent by the patient or the patient's legal representative and/or guardian  Evidence of intracranial hemorrhage (ICH) on baseline CT scan or diagnosis of a non-vascular cause of neurologic deficit NIHSS Level of Consciousness score (1a) >/= 2 Pre-existing disability with mRS > 2 Any evidence of clinically significant bleeding, or known coagulopathy INR >1.5 Patients with an elevated aPTT greater than the upper limit of normal (test can be repeated if investigator suspects a falsely elevated value such as when the collection tube is not completely filled) Patients currently, or within the previous 24 hours, on an oral direct thrombin inhibitor (i.e., dabigatran), a factor 10a inhibitor (i.e., rivaroxaban, apixaban), or any other long-acting anticoagulant Heparin flush required for an IV line. Line flushes with saline only Any history of intra-cranial hemorrhage, known ateriovenous-malformation or unsecured cerebral aneurysms Significant bleeding episode [e.g. gastrointestinal (GI) or urinary tract] within the 3 weeks before study enrollment