Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled...

Area of Science:

• Neurology
• Cardiovascular Medicine
• Pharmacology

Background:

• Intravenous thrombolysis with alteplase is standard for ischemic stroke within 4.5 hours.
• Alteplase has limited reperfusion success for large vessel occlusions before thrombectomy.
• Tenecteplase is being investigated as a potentially more effective alternative.

Purpose of the Study:

• To determine if tenecteplase is non-inferior to alteplase in achieving reperfusion.
• To evaluate tenecteplase's efficacy in patients undergoing endovascular therapy for large vessel occlusion stroke.
• To compare reperfusion rates at initial angiography between tenecteplase and alteplase.

Main Methods:

• EXTEND-IA TNK: a phase II, multicenter, prospective, randomized, open-label, blinded-endpoint non-inferiority study.
• Patients with large vessel occlusion ischemic stroke within 4.5 hours randomized to IV alteplase or tenecteplase before thrombectomy.
• Primary outcome: reperfusion on initial angiogram (modified Treatment in Cerebral Infarction 2b/3).

Main Results:

• Tenecteplase demonstrated non-inferiority to alteplase in achieving reperfusion.
• Assessment of reperfusion rates at initial catheter angiography.
• Evaluation of secondary outcomes including modified Rankin Scale at 90 days and clinical response at 3 days.

Conclusions:

• Tenecteplase is a viable and potentially superior alternative to alteplase for pre-thrombectomy reperfusion in ischemic stroke.
• The study supports the use of tenecteplase in eligible patients with large vessel occlusion.
• Further research may confirm tenecteplase's benefits in stroke treatment.