Tenecteplase Thrombolysis before Thrombectomy in Patients with Ischemic Stroke
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on July 30th, 2025
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Intravenous thrombolysis before endovascular thrombectomy is associated with benefit in the form of enhancing perfusion but with the increased risk of hemorrhage. Several previous studies had found inconsistent results, but most of the studies were conducted with alteplase. With funding from the Chinese government, a study was conducted to assess the usage of tenecteplase before thrombectomy for stroke patients.
The clinical study included 550 participants in China with a median age of 70 years old who had been hospitalized due to ischemic stroke within 4.5 hours from admission to the study. The middle carotid artery is the most common site of occlusion followed by internal carotid and vertebrobasilar arteries. Baseline assessment of neurologic deficits with the National Institutes of Health Stroke Scale found that the cohort have an average age of 16, with 42 indicating the most severe disease.
Before their endovascular thrombectomy, the participants were randomly assigned to receive an infusion with tenecteplase or have the surgery performed without thrombolysis. Tenecteplase is a tissue plasminogen activator that promotes clot breakdown by binding to fibrin and catalyzes the degradation. Assessment at 90 days after surgery found that the usage of tenecteplase before thrombectomy slightly increases the patient's recovery in the form of independence to conduct daily activity. Further subgroup analysis found that clinical benefit is greater in patients who had a smaller clot. Similar to previous studies, participants treated with tenecteplase reported a higher risk of hemorrhage, but this higher risk is not statistically significant.
The clinical study included 550 participants in China with a median age of 70 years old who had been hospitalized due to ischemic stroke within 4.5 hours from admission to the study. The middle carotid artery is the most common site of occlusion followed by internal carotid and vertebrobasilar arteries. Baseline assessment of neurologic deficits with the National Institutes of Health Stroke Scale found that the cohort have an average age of 16, with 42 indicating the most severe disease.
Before their endovascular thrombectomy, the participants were randomly assigned to receive an infusion with tenecteplase or have the surgery performed without thrombolysis. Tenecteplase is a tissue plasminogen activator that promotes clot breakdown by binding to fibrin and catalyzes the degradation. Assessment at 90 days after surgery found that the usage of tenecteplase before thrombectomy slightly increases the patient's recovery in the form of independence to conduct daily activity. Further subgroup analysis found that clinical benefit is greater in patients who had a smaller clot. Similar to previous studies, participants treated with tenecteplase reported a higher risk of hemorrhage, but this higher risk is not statistically significant.