Normal Saline Infusion After Intravenous Thrombolysis in Stroke

Inclusion criteria

• Age 18 to 80 years.
• Acute ischemic stroke treated with intravenous thrombolysis.
• Prestroke mordified Rankin Scale score ≤1;
• Admission NIHSS score 4-25, with NIHSS 4-5 requiring the presence of a disabling deficit as defined in the 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke.
• Onset-to-needle time≤4.5 hours or DWI-FLAIR mismatch (guided by MRI evaluation) for patients with uncertain stroke onset time according to the inclusion criteria of the WAKE-UP study.
• Signed informed consent.

Exclusion criteria

• Contraindications to intravenous thrombolysis.
• Planned endovascular treatment prior to enrollment.
• History of heart failure, or pre-enrollment brain natriuretic peptide (BNP) ≥100 pg/mL, or clinical presentations or signs suggestive of heart failure.
• History of atrial fibrillation, or pre-enrollment electrocardiogram indicating atrial fibrillation.
• History of valvular heart disease or valve replacement surgery, suggesting cardioembolic stroke.
• History of renal dysfunction, or pre-enrollment serum creatinine >133 μmol/L, or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m².
• Severe hemorrhage prior to enrollment, including symptomatic intracranial hemorrhage, gastrointestinal bleeding, respiratory tract bleeding, or massive skin and mucous membrane bleeding.
• Premature termination of intravenous thrombolysis due to any reason, such as hemorrhage, allergic reaction, or seizure.
• Participation in another clinical trial within the previous 3 months.
• Poor compliance, or inability to adhere to the trial protocol or complete follow-up.