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Updated: Jan 7, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tenecteplasa intraarterial en el ictus isquémico agudo tras trombectomía endovascular exitosa: un metaanálisis de
Ocílio Ribeiro Gonçalves1, Mariana Letícia de Bastos Maximiano2, João Vitor Andrade Fernandes3
1Department of Medicine, Federal University of Piauí, Teresina, PI, Brazil.
Background And Purpose:
Although endovascular thrombectomy (EVT) significantly improves outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO), many patients experience incomplete recovery. Adjunctive intra-arterial thrombolysis with tenecteplase (IA-TNK) has emerged as a potential strategy to enhance distal reperfusion. This study aimed to evaluate the efficacy and safety of IA-TNK administered after successful EVT in patients with AIS.
Methods:
PubMed, Web of Science, and Scopus were systematically searched from inception to May 2025. We included randomized controlled trials (RCTs) comparing IA-TNK to standard medical treatment (SMT) after successful EVT (final eTICI 2b-3) in adult patients with AIS due to LVO. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects Mantel-Haenszel models. Heterogeneity was assessed with I². Subgroup and sensitivity analyses were conducted.
Results:
Four RCTs involving 1,160 patients (591 IA-TNK; 569 SMT) were included. IA-TNK significantly increased rates of excellent functional outcome (modified Rankin Scale [mRS] 0-1 at 90 days; RR: 1.22; 95% CI: 1.04-1.44; p = 0.016; I² = 0%) without significant differences in functional independence (mRS 0-2), mortality, symptomatic intracranial hemorrhage, or any intracranial hemorrhage. Subgroup analyses suggested greater benefit in younger patients and those with cardioembolic stroke, with no significant interaction across subgroups.
Conclusions:
Intra-arterial tenecteplase after EVT improves excellent functional outcomes without increasing hemorrhagic risk or mortality. These findings support its use as a safe and potentially effective adjunctive therapy in selected AIS patients, pending further trials.
