Intra-arterial Tenecteplase After Endovascular Recanalisation in Acute Stroke Patients

Interventions

Patients underwent endovascular thrombectomy using various techniques, with the treatment modality chosen by the medical team. In the ATTENTION and BASILAR registries, about 80% of participants with acute basilar artery occlusion underwent thrombectomy, showing a mortality rate of 42% and a morbidity rate of 65%. The ATTENTION-IA trial required neurointerventionists to have extensive experience.

Treatment Groups

Patients were randomized to receive either an intra-arterial infusion of tenecteplase or standard care without adjunctive treatment. Tenecteplase was administered through a catheter near the thrombus, with the dose based on previous trials. Follow-up included radiological assessments and outcome evaluations using standardized scales.

Statistical Analysis

The study analyzed outcomes based on intention-to-treat, adjusting for various factors. It used robust statistical methods to compare treatment effects and conducted subgroup analyses to explore different patient characteristics and treatment responses.

Comparison with Other Studies

Tenecteplase was chosen for its fibrin specificity and longer half-life, showing superiority over alteplase in some trials. The ATTENTION-IA trial observed better outcomes and lower mortality rates compared to previous studies, possibly due to patient selection and successful recanalisation rates.

Limitations

The study's generalizability may be limited by its focus on Chinese patients and the open-label design. The inclusion of patients with low NIHSS scores and the lack of perfusion imaging post-thrombectomy are among the limitations that could affect the interpretation of results.

Conclusion

The trial suggests that intra-arterial tenecteplase after endovascular thrombectomy may offer benefits for certain patients with acute basilar artery occlusion, though further research is needed to confirm these findings and address the study's limitations.