Intravenous Tenecteplase before Thrombectomy in Stroke

Qiu, Zhongming, Li, Fengli, Sang, Hongfei, Yuan, Guangxiong, Xie, Dongjing, Zhou, Kai, Li, Maohua, Meng, Zhaoyou, Kong, Zhenyu, Ruan, Zhongfan, Li, Chaoqun, Yang, Guangui, Wu, Junxiong, Long, Chen, Yang, Bo, Hu, Hai, Li, Yanling, Luo, Jun, Shi, Zhonghua, Huang, Xianjun, Jiang, Shunfu, Yi, Tingyu, Zeng, Guoyong, Liu, Jincheng, Luo, Xiaojun, Liu, Shudong, Chang, Mingze, Wu, Youlin, Tang, Yufeng, Tian, Zhenxuan, Yan, Zhizhong, Zhao, Haojin, Peng, Yuqi, Dai, Hongguo, Zhou, Peiyang, Li, Huagang, Liu, Wenhua, Song, Dengwen, Lei, Bo, Xia, Zhongbin, Tan, Xiaolin, Zhao, Maojun, Feng, Xinggang, Cai, Lingyu, Li, Qi, Wu, Yuelu, Jiang, Bingwu, Tian, Yan, Li, Linyu, Jiang, Ling, Long, Xingmin, You, Feng, Tao, Jian, Zhou, Jin, Wu, Derong, Zheng, Chong, Yin, Congguo, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Lu, Mengjie, Albers, Gregory W., Nogueira, Raul G., Campbell, Bruce C.V., Nguyen, Thanh N., Saver, Jeffrey L., Zi, Wenjie and Yang, Qingwu (2025) 'Intravenous Tenecteplase before Thrombectomy in Stroke'. New England Journal of Medicine. (In Press)

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Abstract

Background
The safety and efficacy of treatment with intravenous tenecteplase before endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion remain uncertain.

Methods
In this open-label trial conducted in China, we randomly assigned patients with acute ischemic stroke due to large-vessel occlusion who had presented within 4.5 hours after onset and were eligible for thrombolysis to receive either intravenous tenecteplase followed by endovascular thrombectomy or endovascular thrombectomy alone. The primary outcome was functional independence (a score of 0 to 2 on the modified Rankin scale; range, 0 to 6, with higher scores indicating more severe disability) at 90 days. Secondary outcomes included successful reperfusion before and after thrombectomy. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and death within 90 days.

Results
A total of 278 patients were randomly assigned to the tenecteplase–thrombectomy group and 272 to the thrombectomy-alone group. Functional independence at 90 days was observed in 147 patients (52.9%) in the tenecteplase–thrombectomy group and in 120 patients (44.1%) in the thrombectomy-alone group (unadjusted risk ratio, 1.20; 95% confidence interval, 1.01 to 1.43; P=0.04). A total of 6.1% of the patients in the tenecteplase–thrombectomy group and 1.1% of those in the thrombectomy-alone group had successful reperfusion before thrombectomy, and 91.4% and 94.1%, respectively, had successful reperfusion after thrombectomy. Symptomatic intracranial hemorrhage within 48 hours occurred in 8.5% of the patients in the tenecteplase–thrombectomy group and in 6.7% of those in the thrombectomy-alone group; mortality at 90 days was 22.3% and 19.9%, respectively.

Conclusions
Among patients with acute ischemic stroke due to large-vessel occlusion who had presented within 4.5 hours after onset, the percentage of patients with functional independence at 90 days was higher with intravenous tenecteplase plus endovascular thrombectomy than with endovascular thrombectomy alone.

Item Type:	Article
Subjects:	WG Cardiovascular System > WG 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1056/nejmoa2503867
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	24 Jun 2025 16:12
Last Modified:	24 Jun 2025 16:12
URI:	https://archive.lstmed.ac.uk/id/eprint/26857

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