Intra-Arterial Tenecteplase After Endovascular Reperfusion for Acute Ischemic Stroke Does Not Improve Disability

Adjunctive intra-arterial tenecteplase did not appreciably improve freedom from disability after acute ischemic stroke due to large vessel occlusion, according to study findings published in JAMA.

“Among patients with large vessel occlusion stroke presenting within 24 hours of time last known to be well and who had achieved near-complete to complete reperfusion after endovascular thrombectomy, adjunctive intra-arterial tenecteplase did not significantly increase the likelihood of freedom from disability,” wrote first author Jiacheng Huang, MD, of The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China, and study coauthors.

The finding stemmed from a randomized clinical trial that spanned 540 patients across 34 hospitals in China between October 26, 2022, and March 1, 2024. The POST-TNK trial included patients with stroke due to proximal intracranial large vessel occlusion within 24 hours of the time they were last known to be well. After endovascular thrombectomy, all patients had achieved scores of 2c to 3 on the expanded Thrombolysis in Cerebral Infarction scale, reflecting near-complete to complete reperfusion.

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Some 269 patients received intra-arterial tenecteplase, and 271 patients received no intra-arterial thrombolysis.

At 90 days, 49.1% of patients who received intra-arterial tenecteplase had modified Rankin Scale scores of 0 or 1, reflecting freedom from disability, compared with 44.1% not treated with intra-arterial thrombolysis. The adjusted risk ratio of 1.15 for freedom from disability with the treatment was not statistically significant, according to the study.

In safety outcomes, 90-day mortality rates were 16.0% with intra-arterial tenecteplase and 19.3% without intra-arterial thrombolysis. Symptomatic intracranial hemorrhage, meanwhile, occurred in 6.3% of patients who received intra-arterial tenecteplase and 4.4% in patients who did not, the study found.

The median age of study participants was 69 years, and 40.9% were women.

Reference

Huang J, Yang J, Liu C, et al. Intra-arterial tenecteplase following endovascular reperfusion for large vessel occlusion acute ischemic stroke: the POST-TNK randomized clinical trial. JAMA. Published online January 13, 2025. doi:10.1001/jama.2024.23466