Intra-arterial tenecteplase during thrombectomy for acute ischemic stroke: the BRETIS-TNK2 trial.
Zi-Ai Zhao, Jing Qiu, Wei Li et al.
✦ AI-curated · Sources linked
In 30 seconds
The phase 3 BRETIS-TNK2 multicentre randomised trial compared intra-arterial tenecteplase during endovascular thrombectomy with thrombectomy alone in patients with large-vessel occlusion eligible for treatment within 24 hours of symptom onset. Among 380 randomised patients, favorable functional outcome at 90 days (modified Rankin Scale 0–2) occurred in 40.0% with tenecteplase and 46.8% with control (unadjusted odds ratio 0.76, [95% CI 0.50-1.14], P = 0.19). The study did not demonstrate improved functional outcomes with adjunctive tenecteplase.
Key findings
- Favorable 90-day functional outcomes occurred in 40.0% of the tenecteplase group versus 46.8% of the control group.
- The unadjusted odds ratio was 0.76, [95% CI 0.50-1.14], P = 0.19.
Why it matters
Adjunctive intra-arterial thrombolysis during thrombectomy has been proposed as a way to improve reperfusion and functional recovery. In this randomised phase 3 study, the primary functional outcome was not better with tenecteplase, so the results do not establish a clinical benefit for adding it to EVT in the studied population.
What to keep in mind
Primary outcome data were available for 190 of 192 patients assigned to tenecteplase and 186 of 188 assigned to control. The abstract reports an unadjusted estimate with a confidence interval spanning no effect.