Intravenous Tenecteplase Enhances Outcomes Prior to Endovascular Thrombectomy

A recent study has revealed that administering intravenous tenecteplase to patients experiencing acute ischemic strokes due to large-vessel occlusion significantly improves their chances of achieving functional independence within 90 days, when given prior to endovascular thrombectomy.

This research was published in the New England Journal of Medicine on May 21, 2025, and coincided with the annual European Stroke Organisation Conference held in Helsinki. The study was led by Zhongming Qiu, M.D., from the Second Affiliated Hospital of Army Medical University in Chongqing, China, and involved a rigorously designed open-label trial.

In this trial, patients presenting within 4.5 hours of stroke onset were randomly assigned to one of two groups: those receiving intravenous tenecteplase followed by endovascular thrombectomy, and those undergoing endovascular thrombectomy alone. The study included a total of 550 participants, with 278 in the tenecteplase group and 272 in the control group.

The primary measure of success was the level of functional independence assessed using the modified Rankin scale, where a score of 0 to 2 indicates lesser disability. The findings indicated that 52.9% of patients in the tenecteplase group achieved functional independence at the 90-day mark compared to 44.1% in the thrombectomy-only group, yielding an unadjusted risk ratio of 1.20.

Furthermore, the study detailed the rates of successful reperfusion prior to thrombectomy, which were 6.1% for the tenecteplase group and 1.1% for the control group. Post-thrombectomy, the rates increased to 91.4% and 94.1%, respectively. However, the incidence of symptomatic intracranial hemorrhage within 48 hours was reported at 8.5% in the tenecteplase group and 6.7% in the control group, while mortality rates at 90 days were noted as 22.3% and 19.9%, respectively.

The authors cautioned that the absence of a consistently significant benefit across secondary outcomes necessitates careful interpretation of these findings. The research was partially funded by a pharmaceutical company, which is a standard practice in clinical trials.

These results suggest that intravenous tenecteplase may serve as a valuable adjunctive treatment for patients suffering from acute ischemic strokes, potentially leading to improved long-term outcomes when administered prior to endovascular interventions.