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Updated: Jun 23, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy
Yunyun Xiong1, Bruce C V Campbell1, Lee H Schwamm1
1From the Department of Neurology (Y. Xiong, Y.J., L. Zong, M.H., Z.C., Liyuan Wang, S.W., Z.L., X.Z., Y.W.), the China National Clinical Research Center for Neurologic Diseases (Y. Xiong, X.M., A.J., Y.J., Y.P., C.D., W.Y., H.L., Y.W.), and the Advanced Innovation Center for Human Brain Protection (Y.W.), the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Y.W.), Beijing, the Department of Neurology, Linyi People's Hospital, Linyi (F.C., H.W., Z.W.), the Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin (Lihua Wang), the Department of Neurology, Weifang People's Hospital, Weifang (L. Zhou), the Department of Emergency Medicine, Linfen Central Hospital, Linfen (H.D.), the Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou (X.L.), the Department of Neurology, First Affiliated Hospital of Zhengzhou University, the National Health Commission Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou (Y. Xu), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), and the Department of Neurology, First People's Hospital of Foshan, Foshan (Z.T.) - all in China; the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C), and the Department of Neurology, University of New South Wales South Western Sydney Clinical School, Liverpool (M.W.P.) - both in Australia; Yale New Haven Health System, Yale School of Medicine, New Haven, CT (L.H.S.); and the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (M.F.).
Tenecteplase treatment for ischemic stroke beyond 4.5 hours improved patient outcomes. This study found tenecteplase led to less disability compared to standard care, with similar survival rates.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Tenecteplase is a thrombolytic drug effective within 4.5 hours of stroke onset.
- Limited data exists on tenecteplase's efficacy in treating stroke patients beyond this 4.5-hour window.
Purpose of the Study:
- To evaluate the effectiveness and safety of tenecteplase in patients with ischemic stroke due to large-vessel occlusion between 4.5 and 24 hours after symptom onset.
- To compare tenecteplase with standard medical treatment in a population not undergoing endovascular thrombectomy.
Main Methods:
- A randomized trial in China assigned 516 patients with large-vessel occlusion and salvageable brain tissue to receive tenecteplase or standard medical treatment.
- Treatment was administered 4.5 to 24 hours after the last known well time.
- The primary outcome was the absence of disability (modified Rankin scale score 0 or 1) at 90 days.
Main Results:
- Tenecteplase treatment resulted in a significantly higher rate of functional independence at 90 days (33.0% vs. 24.2%, P=0.03).
- Mortality rates at 90 days were similar between the tenecteplase group (13.3%) and the standard treatment group (13.1%).
- The incidence of symptomatic intracranial hemorrhage was higher in the tenecteplase group (3.0%) compared to the standard treatment group (0.8%).
Conclusions:
- Tenecteplase administered 4.5 to 24 hours after ischemic stroke onset in patients with large-vessel occlusion led to reduced disability.
- Survival rates were comparable between tenecteplase and standard medical treatment.
- The study suggests a potential increase in symptomatic intracranial hemorrhage with tenecteplase in this extended time window.
