Tenecteplase as an emerging thrombolytic therapy in acute ischemic stroke: a narrative review

Introduction: Acute ischemic stroke (AIS) remains a major cause of mortality and long-term disability worldwide, where rapid reperfusion is essential for improving patient outcomes. Intravenous alteplase has been the standard thrombolytic therapy for eligible patients; however, limitations related to administration and pharmacological properties have encouraged the development of alternative agents. Tenecteplase, a modified tissue plasminogen activator with higher fibrin specificity, longer half-life, and single-bolus administration, has emerged as a promising option. This narrative review evaluates current evidence regarding the efficacy, safety, and clinical role of tenecteplase in acute ischemic stroke management.Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases. Studies published between January 2020 and June 2026 were reviewed using keywords including tenecteplase, TNK-tPA, acute ischemic stroke, alteplase, and thrombolysis. Clinical trials, systematic reviews, meta-analyses, and observational studies evaluating tenecteplase in adult stroke patients were included.Results: Recent evidence indicates that tenecteplase provides comparable efficacy and safety outcomes to alteplase in acute ischemic stroke. Clinical trials and meta-analyses have demonstrated similar rates of functional independence and symptomatic intracranial hemorrhage, supporting its non-inferiority as a thrombolytic agent. The pharmacological advantages of tenecteplase, including rapid administration through a single intravenous bolus, may simplify acute stroke workflows and reduce treatment delays. Increasing evidence supports its use in patients with large vessel occlusion, particularly as bridging therapy before mechanical thrombectomy. Nevertheless, questions remain regarding optimal dosing, patient selection, and implementation in different stroke populations.Discussion/Conclusion: Tenecteplase represents a promising advancement in acute ischemic stroke reperfusion therapy. With growing evidence supporting its efficacy, safety, and practical advantages, it may become an increasingly important component of modern stroke treatment strategies. Further research is required to define its optimal clinical application.Keywords: