Tenecteplase Before Thrombectomy at 4.5 to 24 Hours for Basilar Artery Occlusion: The ATTENTION LATE Randomized Clinical Trial.
Rui Li, Xiaoxi Yao, Raul G Nogueira et al.
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In 30 seconds
This multicenter, open-label, blinded-endpoint randomized clinical trial compared intravenous tenecteplase before endovascular thrombectomy (EVT) with EVT alone in patients with moderate to severe basilar artery occlusion presenting 4.5 to 24 hours after stroke onset. The trial enrolled 330 patients at 40 stroke centers in China. At 90 days, functional independence occurred in 30% of each group: 50 of 165 patients receiving tenecteplase plus EVT and 50 of 164 receiving EVT alone (adjusted rate ratio, 0.92 [95% CI, 0.67 to 1.25]). The addition of tenecteplase did not improve functional outcomes.
Key findings
- Functional independence at 90 days was achieved by 30% in each group: 50 of 165 with tenecteplase plus EVT and 50 of 164 with EVT alone.
- Symptomatic intracranial hemorrhage occurred in 8 patients (5%) with tenecteplase plus EVT and 6 (4%) with EVT alone.
- Ninety-day mortality was 66 (40%) with tenecteplase plus EVT and 70 (43%) with EVT alone.
Why it matters
For patients with moderate to severe basilar artery occlusion presenting in this late time window to EVT-capable centers, the trial found no functional-outcome advantage from adding intravenous tenecteplase before thrombectomy. These results help clarify the role of bridging thrombolysis in this specific setting, while the reported safety outcomes provide relevant context for weighing the intervention.
What to keep in mind
The trial was conducted at stroke centers in China and enrolled patients presenting directly to EVT-capable centers; applicability to other settings or patient groups is uncertain.