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August 20, 2026Stroke and Vascular NeurologyOpen Access

Effectiveness and safety of reperfusion strategies within 4.5 hours for large-vessel occlusion stroke: a network meta-analysis

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Authors

ZHZhilin HuangKYK Y YaoWWWenqian Wei

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Overview

Network meta-analysis reveals tenecteplase combined with thrombectomy yields optimal functional recovery in stroke patients, suggesting tailored reperfusion benefits.

Key Points

  • To compare the comparative effectiveness and safety of various intravenous thrombolysis regimens, endovascular thrombectomy alone, and bridging strategies within 4.5 hours of symptom onset for large-vessel occlusion stroke.
  • Conducted a frequency-based network meta-analysis of randomized clinical trials identified across PubMed, Embase, and Cochrane CENTRAL through August 27, 2025.
  • Included 20 randomized trials enrolling 5,602 adult patients (≥18 years) with imaging-confirmed large-vessel occlusion treated within 4.5 hours.
  • Evaluated 7 reperfusion strategies comparing 90-day functional recovery (mRS 0–1 and 0–2) and safety endpoints (mortality, symptomatic intracerebral hemorrhage, and any intracranial hemorrhage) ranked by SUCRA.
  • For the primary outcome of 90-day excellent functional recovery (mRS 0–1), tenecteplase 0.25 mg/kg plus EVT ranked highest (SUCRA 83.8%), followed by alteplase 0.9 mg/kg plus EVT (SUCRA 72.2%), whereas standalone thrombolysis with alteplase 0.9 mg/kg (SUCRA 14.4%) and tenecteplase 0.4 mg/kg (SUCRA 8.5%) ranked lowest.
  • For safety endpoints, alteplase 0.6 mg/kg plus EVT and EVT alone showed superior rankings for reducing bleeding complications and 90-day mortality, whereas regimens containing tenecteplase 0.4 mg/kg ranked lower in safety.
  • Most direct pairwise comparisons lacked statistical significance with confidence intervals crossing the null, reflecting underlying imprecision and clinical heterogeneity across included trials.

Cite This Study

Huang et al. (2026) studied this question.

synapsesocial.com/papers/6a86b5ff8a91293e6a1cd96fhttps://doi.org/10.1136/svn-2025-004843
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Bridging thrombolysis versus direct thrombectomy in acute ischemic stroke with large vessel occlusion: a network meta-analysis2025 · 4 citations
  2. 2ABSTRACT NUMBER: ESOC2026YS266 TENECTEPLASE THROMBOLYSIS BEYOND 4.5 HOURS: REAL-WORLD DATA IN ISCHEMIC STROKE WITH AND WITHOUT LARGE-VESSEL OCCLUSIONS2026
  3. 3Comparison of the efficacy and safety of different thrombolytic drugs in the treatment of acute ischemic stroke within 4.5 h: a systematic review and network meta-analysis2026
  4. 4Tenecteplase With or Without Mechanical Thrombectomy in Acute Ischemic Stroke at 4.5 to 24 h: An Updated Meta-Analysis of Randomized Controlled Trials2026 · 1 citations
  5. 5Abstract DP076: Thrombectomy vs Thrombolysis vs Bridging Therapy in Late-Window Stroke with Salvageable Tissue: A Network Meta-Analysis of Randomized Controlled Trials2026