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Previous trials have shown that tenecteplase provides comparable results to alteplase when administered within the conventional 4.5-hour time window. Whether the time window for tenecteplase can be expanded with the use of advanced brain imaging techniques is unclear. These investigators conducted an industry-sponsored, multicenter, randomized trial comparing tenecteplase (0.25 mg/kg; maximum dose, 25 mg) to placebo in patients with a documented large-vessel occlusion and with a favorable imaging profile, who could be treated between 4.5 and 24 hours after stroke onset. Favorable imaging was determined by perfusion imaging and included a core infarct volume of <70 mL, a mismatch ratio of at least 1.8, and absolute volume of penumbral tissue…