Abstract Background and aims Incomplete reperfusion following mechanical thrombectomy (MT) occurs in a significant proportion of patients with acute ischemic stroke and is associated with poor clinical outcomes. Intra-arterial tenecteplase (IA-TNK) may enhance reperfusion of residual occlusions that are not amenable to additional mechanical rescue maneuvers. The TECNO trial was designed to evaluate whether IA-TNK improves early and late reperfusion compared with best medical treatment (BMT) alone among patients with incomplete reperfusion. Methods TECNO is an international multicenter clinical trial that will randomize 156 patients with incomplete reperfusion to either IA-TNK or BMT arm (1:1). The two co-primary imaging endpoints were: (1) early reperfusion, defined as improvement in reperfusion on angiography 25 minutes after randomization, and (2) late reperfusion, defined as absence of a perfusion deficit on MR/CT perfusion imaging at 24 h ± 6 h after randomization. The main safety endpoint was symptomatic intracranial haemorrhage assessed in all randomly assigned and consenting participants. Analyses were performed according to the intention-to-treat principle. Results A total of 159 patients were randomized and the primary results of the trial will be presented at ESOC 2026. Conclusions This randomized controlled trial of patients with incomplete reperfusion after MT, will provide evidence on the value of IA TNK as compared to BMT in patients with residual occlusions. Conflict of interest
Kaesmacher et al. (Fri,) studied this question.