Tenecteplase Before Thrombectomy at 4.5 to 24 Hours for Basilar Artery Occlusion
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Importance: Whether intravenous tenecteplase before endovascular thrombectomy (EVT) improves outcomes in patients with basilar artery occlusion presenting 4.5 to 24 hours after stroke onset remains uncertain. Objective: To evaluate the efficacy and safety of intravenous tenecteplase before EVT vs EVT alone in patients with moderate to severe basilar artery occlusion admitted within 4.5 to 24 hours from stroke onset. Design, Setting, and Participants: This multicenter, open-label, blinded end point, randomized clinical trial was conducted at 40 stroke centers in China. Between March 16, 2023, and February 4, 2025, a total of 330 patients with moderate to severe basilar artery occlusion (National Institutes of Health Stroke Scale score ≥10) presenting within 4.5 to 24 hours from stroke onset to EVT-capable centers were enrolled. Final follow-up was completed on May 4, 2025. Interventions: Patients were randomized 1:1 via a centralized web server using a minimization method to receive either intravenous tenecteplase (bolus injection, 0.25 mg/kg; maximum, 25 mg) followed by EVT (n = 166) or EVT alone (n = 164). Main Outcomes and Measures: The primary outcome was functional independence (modified Rankin Scale score, 0-2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Results: Among 332 patients randomized, 2 withdrew consent. Of the remaining 330 patients (mean [SD] age, 66 [11] years; 241 males [73%]; 89 females [27%]), 329 completed 90-day follow-up. Of whom, 50 of 165 (30%) in the tenecteplase plus EVT group and 50 of 164 (30%) in the EVT alone group achieved functional independence (adjusted rate ratio, 0.92 [95% CI, 0.67 to 1.25]; risk difference, -0.18% [95% CI, -10.13% to 9.76%]). Symptomatic intracranial hemorrhage occurred in 8 patients (5%) in the tenecteplase plus EVT group and 6 (4%) in the EVT alone group. Mortality at 90 days was similar between the groups (66 [40%] vs 70 [43%], respectively). Conclusions and Relevance: Among patients with moderate to severe basilar artery occlusion admitted directly to EVT-capable centers who presented 4.5 to 24 hours after stroke onset, the addition of intravenous tenecteplase before EVT did not result in improved functional outcomes compared with EVT alone. Trial Registration: ClinicalTrials.gov Identifier: NCT05701956.
Source: JAMA
Authors: Rui Li, Xiaoxi Yao, Raul G. Nogueira, Guangxiong Yuan, Zhongjun Chen, Wenhuo Chen, Tingyu Yi, Youquan Ren, Junfeng Su, Hao Wang, Zhengfei Ma, Guoyong Zeng, Benxiao Wang, Ming Wei, Shunfu Jiang, Guodong Xiao, Cunfeng Song, Tao Cui, Yaxuan Sun, Yuwen Li, Zhiming Zhou, Xingyun Yuan, Huaizhang Shi, Guang Zhang, Jianshang Wen, Chuanqing Yu, Tao Wang, Jinglun Li, Chuyuan Ni, Fei Wang, Yu Jin, Yao Wang, Zhide Li, Lihua Xu, Bin Mei, Peiyang Zhou, Zhihua Cao, Pu Fang, Hanwen Liu, Juluo Chen, Tao Qiu, Guangsen Cheng, Jie Chen, Yi Sui, Qingbo Lu, Lei Mou, Chunrong Tao, Jun Sun, Cong Luo, Pengfei Xu, Li Wang, Chao Zhang, Tianlong Liu, Jianlong Song, Xiaozhong Jing, Anmo Wang, Jinjing Wang, Guoping Wang, Adnan I. Qureshi, Jeffrey L. Saver, Yuyou Zhu, Thanh N. Nguyen, Wei Hu, ATTENTION LATE Investigators, Gelin Xu, Feng Gao, Yinguang Fan, Juncang Wu, Zi Wang, Juan Chen, Yongwei Zhang, Sen Qun, Chuanqing Fang, Wei Wei, Shuya Yuan, Wei Bao, Hongxing Han, Kai Li, Liping Yu, Chen Long, Li Chen, Junjun Wang
Institutions: University of Science and Technology of China, Chenzhou First People's Hospital, University of Pittsburgh, UPMC Health System, University of Pittsburgh Medical Center, Dalian Medical University, Dalian Municipal Central Hospital, Fujian Medical University, Linquan County People's Hospital, Yangtze University, Linyi People's Hospital, Anhui Medical University, Ganzhou People's Hospital, Tianjin Huanhu Hospital, Second Affiliated Hospital of Soochow University, Taihe Hospital, Shanxi Provincial People’s Hospital, Heze Municipal Hospital, Wannan Medical College, First Affiliated Hospital of Wannan Medical College, First People's Hospital of Xianyang, First Affiliated Hospital of Harbin Medical University, Anhui University of Science and Technology, Southwest Medical University, Affiliated Hospital of Southwest Medical University, Bozhou People's Hospital, Jiamusi University, Zhongnan Hospital of Wuhan University, Hubei University of Medicine, Xiang Yang No.1 People's Hospital, First Affiliated Hospital of Nanchang University, Guangdong Provincial People's Hospital, The People's Hospital Tongling, Zigong First People's Hospital, Zhuhai People's Hospital, Shenyang First People's Hospital, University of Minnesota, University of California, Los Angeles, Boston University, Boston Medical Center
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7214117662