Key result
Tenecteplase significantly increased major reperfusion without symptomatic intracranial hemorrhage compared to best medical treatment (33.3% vs 10.8%; RR 3.0; 95% CI 1.6-5.7; P=0.001).
Why the study?
Whether extending the time window of intravenous thrombolysis up to 24 hours after the last known well is effective and safe was unknown.
Does intravenous tenecteplase improve major reperfusion without symptomatic intracranial hemorrhage in patients with acute ischemic stroke due to large/medium vessel occlusion presenting 4.5 to 24 hours from last known well?
Population
224 Chinese acute ischemic stroke patients with large/medium vessel occlusion presenting 4.5 to 24 hours from onset
Comparison
0.25 mg/kg tenecteplase vs best medical treatment
Design
Randomized clinical trial
Follow-up
90 days
Authors
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Does not support practice change for functional outcomes; extends late-window reperfusion evidence but leaves 90-day benefit open.
RCT (n=224)
1:1
Does intravenous tenecteplase improve major reperfusion without symptomatic intracranial hemorrhage in patients with acute ischemic stroke due to large/medium vessel occlusion presenting 4.5 to 24 hours from last known well?
Relative Risk: 3 (95% CI 1.6–5.7)
Absolute Event Rate: 33.3% vs 10.8%
p-value: p=0.001
In patients with late-window acute ischemic stroke selected by perfusion imaging, tenecteplase increased reperfusion without symptomatic intracranial hemorrhage but did not improve 90-day clinical outcomes.
Cheng et al. (2025) conducted an RCT in acute ischemic stroke due to large/medium vessel occlusion (n=224). Tenecteplase vs. best medical treatment was evaluated on achievement of major reperfusion without symptomatic intracranial hemorrhage within 24 to 48 hours post-randomization (RR 3.0, 95% CI 1.6-5.7, p=0.001). Tenecteplase significantly increased major reperfusion without symptomatic intracranial hemorrhage compared to best medical treatment (33.3% vs 10.8%; RR 3.0; 95% CI 1.6-5.7; P=0.001).
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