The TRACE-5 study was a multicenter, prospective, randomized, open-label, endpoint-blinded, phase 3 superiority study at 66 stroke centers in China.[1][2] It included 452 patients aged 18 years and older with CTA/MRA-confirmed ischemic stroke due to basilar artery occlusion within 24 hours of symptom onset and with a pre-event mRS score ≤3.[1][2] Patients were randomized to tenecteplase at a dose of 0.25 mg/kg (max. 25 mg) as a single bolus or standard medical therapy, including alteplase in 35% of patients in the control group, with the option of endovascular treatment in both groups.[1][2] The primary endpoint—achieving an mRS score of 0-1 or return to baseline mRS at 90 days—was achieved in 38% of patients in the tenecteplase group (83/218) versus 29% in the control group (66/228), with an adjusted OR of 1.50 (95% CI 1.09-2.08; p=0.014).[1][2] Symptomatic intracranial bleeding within 36 hours occurred in 2% of tenecteplase patients (4/218) and 3% in the control group (7/234), with an adjusted OR of 0.58 (95% CI 0.17-1.99).[2] The incidence of death was similar in both groups.[1][2] Thus, tenecteplase improved functional outcome in Chinese patients with basilar artery occlusion without an increased risk of bleeding or death.[1][2]