N Engl J Med

Tenecteplase before thrombectomy improves stroke outcomes

May 29, 2025

For patients with large-vessel occlusion stroke presenting within 4.5 hours, IV tenecteplase prior to thrombectomy modestly increases the likelihood of functional independence at 90 days without a significant increase in symptomatic intracranial hemorrhage or mortality. These findings support the use of tenecteplase as a bridging therapy in eligible patients undergoing thrombectomy.

Study details: The BRIDGE-TNK multicenter, open-label randomized trial in China enrolled 550 adults with acute ischemic stroke due to large-vessel occlusion within 4.5 hours of onset, all eligible for IV thrombolysis. Patients were randomized to receive IV tenecteplase (0.25 mg/kg) prior to endovascular thrombectomy, or thrombectomy alone. The primary endpoint was functional independence (modified Rankin Scale [mRS] 0–2) at 90 days. Key secondary and safety outcomes included successful reperfusion before and after thrombectomy, symptomatic intracranial hemorrhage, and 90-day mortality.

Results: Functional independence at 90 days was achieved in 52.9% of the tenecteplase-thrombectomy group vs. 44.1% with thrombectomy alone (risk ratio, 1.20; 95% confidence interval [CI], 1.01–1.43; P=0.04). Successful reperfusion before thrombectomy was more frequent with tenecteplase (6.1% vs. 1.1%), but post-thrombectomy reperfusion rates were similar (91.4% vs. 94.1%). Symptomatic intracranial hemorrhage (8.5% vs. 6.7%) and 90-day mortality (22.3% vs. 19.9%) weren't significantly different between groups.

Source:

Qiu Z, et al; BRIDGE-TNK Trial Investigators. (2025, May 21). N Engl J Med. Intravenous Tenecteplase before Thrombectomy in Stroke. https://pubmed.ncbi.nlm.nih.gov/40396577/