Inclusion CriteriaSubjects may be included in the study only if they meet all of the following criteria:
1. Subject is at least 40 years of age at screening, but has not had their 81st birthday.
2. Subject has received IV rt-PA per the NINDS rt-PA Protocol Guidelines within 3 hours of symptom onset for an acute ischemic stroke.
3. Subject is diagnosed with acute ischemic stroke and presents to the health care facility at a time such that initiation of NTS procedure is feasible within 6 hours of the time of stroke onset. The time of stroke onset is defined as the time at which a change in the baseline neurological function occurred. If the time is not known (e.g., the subject awakens from sleep with new symptoms), the last time the patient was observed to be neurologically intact must be considered to be the time of onset.
4. Documented baseline NIHSS score of > 7 and < 17 prior to IV rt-PA administration. Subjects who transfer from other facilities after receiving IV rt-PA must have a documented NIHSS by a certified examiner prior to initiation of rt-PA treatment. Documentation of NIHSS score via telemedicine is acceptable if performed by a certified examiner. Subjects who improve prior to NTS procedure will still be treated, unless their NIHSS improves to 0.
5. Full functional independence just prior to the present stroke episode as defined by the following criteria:
- Estimated prestroke mRS score 0 or 1.
- Ambulates independently, may need a cane or walker, but does not need the assistance of another person.
- Absence of a medical/physical/mental condition that substantially limits the subject's ability to work, study, participate in leisure activities, or look after family at home
- Completely independent, does not need supervision (may live with other individuals, but could live alone if necessary)
6. Negative serum or urine pregnancy test in females of childbearing potential.
7. Subject (or legally authorized representative) provides written Informed Consent in compliance with local regulations prior to enrollment into this study.
8. The subject (and caregiver, if applicable) is willing to participate in this study for at least 90 days after the onset of stroke.-
Exclusion Criteria1. Evidence on from a pre-tPA head CT of an intracranial, subdural, or subarachnoid hemorrhage or clinical presentation suggestive of subarachnoid hemorrhage even if the initial neuroimaging scan is normal.
2. Clinical presentation consistent with a brainstem or cerebellar stroke
3. A rapidly improving neurological status that in the opinion of the investigator will make the subject unsuitable for participation in this study or patient rapidly improves to NIHSS of 0 by start of NTS procedure.
4. The subject had a seizure at stroke onset or within the 7 days prior to stroke onset.
5. Sustained blood glucose > 300 mg/dl or < 60 mg/dl
6. Subjects who, on repeated measurement, have a systolic blood pressure > 185, or a diastolic blood pressure > 110mmHg, post rt-PA administration, or it is the opinion of the investigator that aggressive treatment to reduce blood pressure post thrombolysis is required to keep pressure within these limits.
7. Presumed and/or confirmed septic embolus.
8. The subject has a history of CNS vascular wall disease (e.g. aneurysm, AVM).
9. The subject has a history of CNS disease or damage (e.g. neoplasm or dementia) which may influence the subject's outcome assessment.
10. The subject has a significant skin condition (i.e., hemangioma, scleroderma, psoriasis, rash, open wound or tattoo) on their scalp that is found to be directly below three or more TLT procedure sites.
11. Planned or actual use of any intra-arterial thrombolytic medication or a clot retrieval device, or any diagnostic or therapeutic interventional neurovascular procedure, including mechanical recanalization, whether successful or unsuccessful, during this stroke episode.
12. Subject previously participated in another investigational drug or device trial within the preceding four weeks.
13. Subject is a female who is pregnant or lactating (within the previous 30 days),or who is of child-bearing potential unless she is surgically sterile or she and/or her partner are using a medically acceptable method of birth control.
14. The subject has an implant of any kind in the head (i.e. clipped aneurysm, embolised AVM, implantable shunt - Hakim valve).
15. Any use of light-activated drugs (photodynamic therapy) within 14 days prior to study enrollment.
16. The subject participated in the NEST-1, NEST-2, or NEST-3 Study.
17. The subject has any co-existing or terminal disease that may limit life expectancy or any medical condition (e.g. morbid obesity, substance abuse) that may, in the clinical judgment of the Investigator, independently influence the subject's outcome during the course of the study.
18. The subject is otherwise determined, based on the opinion of the Investigator,to be an unsuitable candidate for enrollment in this study. -