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Updated: Jan 30, 2026

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Tenecteplase in large-vessel occlusion with or without thrombectomy: a meta-analysis
Ahmed Alkhiri1, Aser F Alamri1, Fahad Alturki1
1Neuroscience Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Tenecteplase improves outcomes for large-vessel occlusion stroke patients, especially when given before endovascular thrombectomy (EVT) within 4.5 hours. Extended window use with neuroimaging is beneficial for selected patients without EVT access.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Large-vessel occlusion (LVO) stroke treatment is evolving, with Tenecteplase gaining traction.
- Uncertainty remains regarding optimal Tenecteplase use, particularly bridging therapy and extended windows in LVO patients with or without endovascular thrombectomy (EVT).
Purpose of the Study:
- To systematically review randomized clinical trial (RCT) data on Tenecteplase use in LVO patients.
- To evaluate outcomes based on EVT status and treatment windows (≤4.5 hours vs. >4.5 hours).
Main Methods:
- Systematic review of RCTs involving LVO patients treated with or without Tenecteplase.
- Outcomes analyzed by EVT status and treatment window.
- Disability reduction assessed using modified Rankin Scale (mRS) shift analysis (gORs).
- Functional independence, excellent outcome, mortality, and symptomatic intracranial hemorrhage (sICH) analyzed using risk ratios (RRs).
Main Results:
- Tenecteplase use was linked to greater disability reduction (gOR, 1.19) and improved functional independence (RR, 1.14) versus no thrombolysis.
- No significant differences in sICH (RR, 1.46) or mortality (RR, 1.07) were observed.
- Tenecteplase within 4.5 hours improved outcomes before EVT; no benefit was seen beyond 4.5 hours with EVT.
- Tenecteplase after 4.5 hours improved outcomes in EVT-ineligible LVO patients with salvageable tissue on CT perfusion.
Conclusions:
- Intravenous Tenecteplase improves outcomes in LVO patients.
- Benefit observed when administered before EVT within 4.5 hours.
- Extended window Tenecteplase, guided by neuroimaging, benefits selected patients without EVT access.
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