Neurology in critical care · Bridging thrombolysis before thrombectomy
Intravenous Tenecteplase before Thrombectomy in Stroke
| Design | Phase 2-3 randomised controlled trial |
|---|---|
| Treatment | Intravenous tenecteplase followed by thrombectomy |
| Control | Thrombectomy alone |
| Population | 550 patients with acute ischaemic stroke from large-vessel occlusion presenting within 4.5 hours |
| Follow-up | 90 days |
| Primary endpoint | Functional independence at 90 days |
| Result | Functional independence at 90 days occurred in 147 of 278 (52.9%) with tenecteplase plus thrombectomy, higher than with thrombectomy alone among the 272 control patients. |
| Secondary endpoints | Modified Rankin shift, reperfusion before thrombectomy, symptomatic haemorrhage |
Among patients with acute ischemic stroke due to large-vessel occlusion who had presented within 4.5 hours after onset, the percentage of patients with functional independence at 90 days was higher with intravenous tenecteplase before thrombectomy than with thrombectomy alone.
The trial authors, in the published abstract
Settles a genuine controversy: several earlier trials suggested thrombectomy alone might suffice and spare the bleeding risk. It does not. Bridging thrombolysis stays, at least within 4.5 hours of onset.
Qiu Z, Li F, Sang H, et al. Intravenous Tenecteplase before Thrombectomy in Stroke. N Engl J Med 2025 Jul 10;393(2):139-150.