Abstract Body: BACKGROUND
The role of intra-arterial tenecteplase for acute large vessel occlusion after successful endovascular therapy is uncertain.
METHODS
We conducted a multicenter, prospective, open-label, randomized trial in China of patients with acute anterior circulation large vessel occlusion treated between 4.5 to 24 hours from the time that the patient was last known to be well. After successful endovascular recanalization, defined as eTICI 2b50 or greater, patients were randomly allocated in a 1:1 ratio to receive intra-arterial tenecteplase or standard medical management. The primary endpoint was 90-day excellent outcome defined as modified Rankin Scale (mRS) 0 to 1. Secondary endpoints include 90-day ordinal mRS, mRS 0 to 2, mRS 0 to 3, all-cause mortality, and any intracranial hemorrhage. The primary safety outcome was symptomatic intracranial hemorrhage within 48 hours.
RESULTS
A total of 255 patients were enrolled; 127 assigned to the intra-arterial tenecteplase group and 129 to the standard medical management group. Intra-arterial tenecteplase after endovascular therapy resulted in a higher percentage of patients with a modified Rankin scale score of 0 or 1 at 90 days than standard medical treatment. (40.5% vs. 26.4%; relative rate 1.44; 95% confidence interval, 1.06 to 1.95, P=0.02). Mortality at 90 days was 21.4% with intra-arterial tenecteplase and 21.7% with standard medical treatment (P=0.39). The incidence of symptomatic intracranial hemorrhage within 48 hours after treatment was 5.6% and 6.2%, respectively (P=0.92).
CONCLUSION
In patients with acute large vessel occlusion presenting between 4.5 to 24 hours, intra-arterial tenecteplase after successful thrombectomy resulted in a greater likelihood of excellent neurological outcome at 90 days. (ANGEL-TNK ClinicalTrials.gov number, NCT05624190)