Pre‐stroke mRS > 1 (patients who have inability to carry out all daily activities and require some help or supervision)
Contraindications in the Japanese guideline for the intravenous application of recombinant tissue‐type plasminogen activator (alteplase)
History of non‐traumatic intracranial haemorrhage
History of stroke within the last 1 month (excluding transient ischaemic attack)
History of significant head/spinal injury or surgery within the last 3 months
History of gastrointestinal or urinary tract bleeding within the last 21 days
History of major surgery or significant trauma other than head injury within the last 14 days
Hypersensitivity to alteplase
Suspected subarachnoid haemorrhage
Concurrent acute aortic dissection
Concurrent haemorrhage (e.g. intracranial, gastrointestinal, urinary tract, or retroperitoneal, haemoptysis)
Systolic blood pressure ≥ 185 mmHg despite antihypertensive therapy
Diastolic blood pressure ≥ 110 mmHg despite antihypertensive therapy
Significant hepatic disorder
Acute pancreatitis
Blood glucose < 50 mg/dL or > 400 mg/dL
Platelet count ≤ 100,000/mm3
International normalised ratio of prothrombin time > 1.7 or prolonged aPTT > 1.5 times the baseline value (> approximately 40 seconds only as a guide) for patients on anticoagulation therapy or those with abnormal coagulation
Any contraindication to MRI (e.g. cardiac pacemaker)
Extensive early ischaemic change in brainstem or cerebellum (e.g. more than half of brainstem or more than 1 hemisphere of cerebellum)
Planned or anticipated treatment with surgery or endovascular reperfusion strategies (e.g. intra‐arterial thrombolysis, mechanical recanalisation techniques)
Pregnant, lactating, or potentially pregnant
Life expectancy 6 months or less by judgement of the investigator
Inappropriate for study enrolment by judgement of the investigator