Intra-Arterial Tenecteplase After Stroke Thrombectomy: More Data, More Questions

Clinical Takeaway

: A randomized trial in China finds improved outcome with intra-arterial tenecteplase following thrombectomy, but further confirmatory trials are needed.

Context

Endovascular thrombectomy (EVT) is a proven treatment for select patients with acute ischemic stroke who have a large-vessel occlusion. Some patients do not achieve a good outcome after EVT, and one potential reason is occlusion of the microvasculature (NEJM JW Neurol Sep 3 2025 and JAMA Neurol 2025; 82:895). Intra-arterial (IA) lytic agents such as tenecteplase might help “clear” downstream emboli and improve flow in the microvessels. To test this hypothesis, researchers in China conducted a randomized trial of IA tenecteplase (0.125 mg/kg) versus standard medical treatment in 256 patients who received successful EVT in the 4.5- to 24-hour time window after stroke. The primary outcome was excellent neurologic status, defined as modi…

Reviewing Author

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke