Related Experiment Video
Updated: Jun 13, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tenecteplase in the Extended 4.5-24-Hour Window for Acute Ischemic Stroke: An Updated Meta-Analysis of RCTs with
Sadia Qazi1, Arsalan Ahmed2, Mazhar Ali3
1Department of Anatomy, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.
Healthcare (Basel, Switzerland)
|June 12, 2026
Summary
Tenecteplase improves excellent functional outcomes for acute ischemic stroke (AIS) beyond 4.5 hours, regardless of endovascular thrombectomy (EVT) availability. Benefits in recanalization and early improvement were greater in non-EVT settings, but functional recovery did not proportionally increase.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- The effectiveness of tenecteplase in treating acute ischemic stroke (AIS) beyond the standard 4.5-hour window is not well-established, especially when considering different treatment pathways involving endovascular thrombectomy (EVT).
- An updated systematic review and meta-analysis were conducted to address this uncertainty, stratifying results based on EVT availability.
Purpose of the Study:
- To evaluate the efficacy of tenecteplase in imaging-selected AIS patients presenting between 4.5 and 24 hours from last known well.
- To compare outcomes in patients treated with and without EVT.
Main Methods:
- A systematic search of major databases (PubMed, Embase, Scopus, Cochrane Library) was performed for relevant randomized controlled trials up to February 2026.
- Meta-analysis using random-effects models with Hartung-Knapp adjustment was employed, with subgroup analyses stratified by EVT availability.
Main Results:
- Tenecteplase significantly improved excellent functional outcomes (mRS 0-1) at 90 days (RR 1.25, p=0.0005) with no heterogeneity or interaction by EVT status.
- While recanalization and early neurological improvement showed benefits concentrated in non-EVT settings (p-interaction <0.01), these did not proportionally translate to functional recovery.
- No significant differences were observed in good functional outcome, symptomatic intracranial hemorrhage, or 90-day mortality.
Conclusions:
- Tenecteplase administration in imaging-selected AIS patients presenting within 4.5-24 hours improves excellent functional outcomes, irrespective of EVT availability.
- Observed benefits in recanalization and early neurological improvement were primarily in non-EVT settings, highlighting the need to distinguish intermediate endpoints from patient-centered outcomes.
- Future trials for extended-window AIS treatment should clearly define EVT status to refine treatment strategies.
Related Concept Videos
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...