Acute ischemic stroke: imaging-guided tenecteplase treatment in an extended time window

Area of Science:

• Neurology
• Pharmacology
• Radiology

Background:

• Tenecteplase is a fibrin-specific tissue plasminogen activator with a prolonged half-life compared to alteplase.
• This study investigates tenecteplase in acute ischemic stroke treatment.

Purpose of the Study:

• To evaluate the efficacy of tenecteplase in acute ischemic stroke patients within an extended time window.
• To compare reperfusion rates and neurological improvement between tenecteplase and alteplase treatments.

Main Methods:

• A prospective, nonrandomized pilot study involving 0.1 mg/kg IV tenecteplase (3-6 hours post-stroke) versus historical controls of 0.9 mg/kg IV alteplase (sub-3-hour).
• Advanced imaging (CT/MRI) was used for pretreatment assessment and 24-hour follow-up, with specific criteria for tenecteplase eligibility.
• Primary outcomes included reperfusion and major vessel recanalization, assessed blindly.

Main Results:

• The tenecteplase group demonstrated significantly greater reperfusion (74% vs. 44%) and major vessel recanalization (10/15 vs. 7/29) compared to the alteplase group.
• Despite later treatment initiation, tenecteplase led to more major neurologic improvements at 24 hours (10/15 vs. 7/35).
• No parenchymal hematomas were observed in the tenecteplase group, versus four in the alteplase group.

Conclusions:

• Tenecteplase shows promising biologic efficacy in acute ischemic stroke when used with advanced imaging in an extended window.
• Differences in imaging selection criteria limit direct efficacy comparison between the groups.
• Results support randomized trials comparing tenecteplase and alteplase, ideally using imaging-guided selection.