Occlusion site and outcomes in intra-arterial tenecteplase after successful endovascular therapy: a secondary analysis of the ANGEL-TNK trial.
J Neurointerv SurgSep 14, 2026 (epub)
Shuo Li, Xin Tong, Huachen Zhang et al.
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In 30 seconds
This secondary analysis of the ANGEL-TNK trial evaluated the efficacy of intra-arterial tenecteplase in patients with large vessel occlusion (LVO) stroke, focusing on occlusion sites (internal carotid artery vs. middle cerebral artery). Among 256 patients, those with ICA occlusions treated with tenecteplase showed a significantly higher rate of 90-day modified Rankin Scale (mRS) 0-1 outcomes (39.4% vs 13.2%; RR 2.99; p=0.002) compared to standard management.
Key findings
- ICA occlusion patients treated with IA tenecteplase had a 39.4% rate of mRS 0-1 compared to 13.2% in controls.
- The rate of mRS 0-3 was 54.5% in the tenecteplase group versus 42.1% in controls.
- IA tenecteplase resulted in lower intracranial hemorrhage rates (15.2% vs 39.5%; RR 0.38; p<0.001) in ICA patients.
Why it matters
Understanding the differential efficacy of intra-arterial tenecteplase based on occlusion site can guide treatment decisions in LVO stroke, potentially improving patient outcomes and reducing complications.