Introduction: Recent trials suggest that treatment of acute ischemic stroke due to large vessel occlusion with tenecteplase (tNK) alone results in recanalization in up to 20% of cases. Beyond early recanalization, tNK administration prior to mechanical thrombectomy (MT) has the potential to facilitate first pass, improve Thrombolysis in Cerebral Infarction (TICI) score through dissolution of distal clot fragments, and ultimately result in improved functional outcomes. The goal of our study was to determine if tNK prior to MT significantly impacted likelihood of first pass success, final TICI score, or Modified Rankin Scale (mRS) at 90 days specifically in patients who undergo MT within nine hours from last known well. Methods: This retrospective cohort study included 236 patients with acute ischemic stroke who underwent MT within nine hours of the last known well at an academic tertiary referral center from January 2023 to June 2025. Patients were stratified based on receipt of tNK prior to MT. Efficacy outcomes included first pass success, MT success (defined as TICI 2C or better) and 90-day mRS. The primary safety endpoint was symptomatic intracranial hemorrhage (sICH) at 36 hours. Results: Of the 236 patients included, 106 patients received tNK prior to MT. There was no significant difference in MT first pass success between the two groups (50% in tNK group vs. 49% in non-tNK group; X 2 = 0; p = 1.0). There was no significant difference in the number of patients achieving MT success with TICI 2C or better (57% in tNK group vs. 69% in non-tNK group; X 2 = 2.97; p = 0.085). A larger number of patients in the tNK group had mRS of 0–2 at 90 days (48%) compared to the non-tNK group (39%), but this was not statistically significant (X 2 = 1.53; p = 0.216). There was no significant difference in sICH within 36 hours (1.8% in tNK group vs. 0% in non-tNK group; p = 0.39). Conclusion: Administration of tNK prior to MT did not improve first-pass or overall MT success, and while there was a trend toward better functional outcomes, this finding did not reach statistical significance. The sICH rates were comparable between the two groups. Ultimately, this single-center study suggests that tNK does not confer added procedural benefit in patients undergoing MT. However, its use in MT candidates remains appropriate as successful early recanalization may occur, subsequently avoiding thrombectomy.
Skorseth et al. (Thu,) studied this question.