Intravenous Tenecteplase before Thrombectomy in Stroke.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• The efficacy and safety of using tenecteplase prior to endovascular thrombectomy for acute ischemic stroke caused by large-vessel occlusion are not well-established.
• Large-vessel occlusion strokes require rapid and effective interventions to restore blood flow and minimize brain damage.

Purpose of the Study:

• To evaluate the effectiveness of intravenous tenecteplase combined with endovascular thrombectomy compared to endovascular thrombectomy alone.
• To assess functional independence and reperfusion rates in patients with acute ischemic stroke.

Main Methods:

• An open-label, randomized trial was conducted in China involving patients with acute ischemic stroke due to large-vessel occlusion presenting within 4.5 hours.
• Patients received either tenecteplase followed by thrombectomy or thrombectomy alone.
• The primary outcome was functional independence at 90 days, assessed using the modified Rankin scale.

Main Results:

• Functional independence at 90 days was achieved in 52.9% of patients in the tenecteplase-thrombectomy group versus 44.1% in the thrombectomy-alone group (P=0.04).
• Successful reperfusion before thrombectomy was higher in the tenecteplase group (6.1% vs 1.1%).
• Symptomatic intracranial hemorrhage rates were 8.5% and 6.7%, respectively, with 90-day mortality at 22.3% and 19.9%.

Conclusions:

• Intravenous tenecteplase plus endovascular thrombectomy resulted in a higher percentage of functionally independent patients at 90 days compared to endovascular thrombectomy alone.
• The findings suggest that tenecteplase pre-treatment is a beneficial strategy for select acute ischemic stroke patients.
• Further research may explore optimizing patient selection and treatment protocols for this combined approach.