A recent study published in the New England Journal of Medicine reveals that tenecteplase, a thrombolytic agent, is effective in treating ischemic stroke even when administered beyond the conventional 4.5-hour window. The trial, conducted in China, offers promising results for patients who miss this critical time frame.
The trial involved 516 patients with large-vessel occlusion in the middle cerebral artery or internal carotid artery, confirmed to have salvageable brain tissue through perfusion imaging. These patients, who were ineligible for endovascular thrombectomy, were randomly assigned to receive either tenecteplase or standard medical treatment between 4.5 to 24 hours after they were last known to be well.
Results indicated that 33% of patients treated with tenecteplase achieved minimal disability, defined as a score of 0 or 1 on the modified Rankin scale, by day 90, compared to 24.2% in the standard treatment group. This represents a relative rate of 1.37 (95% confidence interval, 1.04 to 1.81; P=0.03). Mortality rates at 90 days were similar between the two groups, with 13.3% in the tenecteplase group and 13.1% in the standard treatment group. However, the incidence of symptomatic intracranial hemorrhage within 36 hours post-treatment was higher in the tenecteplase group (3.0%) compared to the standard treatment group (0.8%).
This study suggests that tenecteplase could be a viable option for stroke patients who are unable to receive treatment within the standard 4.5-hour window, potentially improving outcomes for a broader range of patients.