Intravenous Tenecteplase Beneficial Before Endovascular Thrombectomy

FRIDAY, May 23, 2025 (HealthDay News) — For patients with acute ischemic stroke due to large-vessel occlusion who present within 4.5 hours, intravenous tenecteplase before endovascular thrombectomy is associated with higher functional independence at 90 days, according to a study published online May 21 in the New England Journal of Medicine to coincide with the annual European Stroke Organisation Conference, held from May 21 to 23 in Helsinki.

Zhongming Qiu, M.D., from the Second Affiliated Hospital of Army Medical University in Chongqing, China, and colleagues conducted an open-label trial in China involving patients with acute ischemic stroke due to large-vessel occlusion who presented within 4.5 hours after onset and were eligible for thrombolysis. Participants were randomly assigned to receive either intravenous tenecteplase followed by endovascular thrombectomy or endovascular thrombectomy alone (278 and 272 patients, respectively). The primary outcome was functional independence (a score of 0 to 2 on the modified Rankin scale, with higher scores indicating more severe disability) at 90 days.

The researchers found that 52.9 and 44.1 percent of patients in the tenecteplase-thrombectomy group and the thrombectomy-alone group, respectively, had functional independence at 90 days (unadjusted risk ratio, 1.20). Overall, 6.1 and 1.1 percent of patients, respectively, in the tenecteplase-thrombectomy group and the thrombectomy-alone group had successful reperfusion before thrombectomy, while 91.4 and 94.1 percent, respectively, had successful reperfusion after thrombectomy. Symptomatic intracranial hemorrhage within 48 hours occurred in 8.5 and 6.7 percent of patients, respectively, in the tenecteplase-thrombectomy group and the thrombectomy-alone group; mortality at 90 days was 22.3 and 19.9 percent, respectively.

“The lack of a consistent significant benefit across secondary outcomes makes this finding tenuous,” the authors write.

The study was funded in part by China Shijiazhuang Pharmaceutical Company Recomgen Pharmaceutical.

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