Abstract Background and aims In a single-center study, we evaluated the efficacy and safety of using intra-arterial Tenecteplase (IA-TNK) for treating medium and distal vessel occlusions in patients with ischemic stroke. Methods We reviewed patients treated from January 2024 to October 2025. We administered a maximum dose of 10 mg of IA-TNK in 2.5mg increments via super-selective catheterization. CT perfusion studies graded angiographic evidence of perfusion. Neurological examinations were performed before, 24 hours, and 7 days post-treatment. Functional outcomes were evaluated using the modified Rankin scale (mRS) at 30 days post-treatment. Results Ten patients received IA-TNK (median age, 68 years). The baseline National Institutes of Health Stroke Scale scores (NIHSS) ranged from 5 to 18, and the baseline Alberta Stroke Program Early CT Score ranged from 8 to 10. Four patients received adjunctive intravenous thrombolysis and/or carotid stenting. Early neurological improvement (ENI), defined as a decrease of four or more points in NIHSS, occurred in 70% of patients within 24 hours and in 90% by 7 days, with no intracranial hemorrhage. CT perfusion revealed a reduction in Tmax 6s median volume from 52.5 mL to 17 mL. At 30 days, functional independence, defined as an mRS score of 0–2, was achieved in seven patients, and an mRS score of 3 was achieved in one patient. Two patients had mRS scores of 5 or 6 because of terminal malignancy. Conclusions In our experience, IA-TNK in doses up to 10mg, with or without adjunctive therapies, appeared safe and was associated with early neurological improvement. Conflict of interest Syed Gillani: nothing to disclose/ Hatem Tolba: nothing to disclose/ Sinan Tatli:nothing to disclose/ Ahmed Hassan: nothing to disclose/ Balint Otvos: nothing to disclose/ Farhan Siddiq: nothing to disclose/ Camilo Gomez: nothing to disclose/ Adnan Qureshi: nothing to disclose.
Gillani et al. (Fri,) studied this question.