Better hope after thrombectomy with IA tenecteplase

It is safe to administer intra-arterial (IA) tenecteplase (TNK) after successful reperfusion with mechanical thrombectomy and is more functional than standard medical management in patients with precirculatory vascular occlusion (LVO) stroke It will bring about the results.

Adding IA TNK “increases the proportion of these patients who are actually doing well,” says Xiaochuan Huo, MD, PhD, director of the Neurological Disease Centre at Beijing Anzen Hospital in China Medscape Medical News.

It's the effect of drugs that destroy blood clots “is additive on top of thrombectomy. It pushes the boundaries even further as to how well thrombectomy helps patients,” Huo adds. I did.

The survey results were presented on February 7th. International Stroke Conference 2025.

Towards better results

Studies have shown that patients who have experienced stroke due to LVO often have inadequate outcomes. Even after successful recurrence from intravascular thrombectomy (EVT), up to half of these patients still face unfavorable prognosis.

This can be due to patient comorbidities, post-stroke medical complications, or persistent impairment of previously occluded vessel flow. As Huo pointed out, endovascular treatment may not effectively restore the flow of smaller blood vessels and microcirculatory.

As a result, the researchers pivoted to post-reperfusion therapy to further improve patient outcomes.

IIB Chemical Optimization of Brain Embolization (choice) trial showed patients randomly assigned to IA alteplase after EVT was likely to have a 90-day excellent functional outcome (modified Rankin score) [mRS]0-1) those receiving a placebo (59% vs. 40%, adjusted risk difference, 18.4%, 95% CI, 0.3-36.4%; p = .047).

However, due to the lack of placebo supply, the elective trial was completed early due to the ability to maintain enrollment rates.

Huo noted that there was no direct comparison between IA alteplase and IA TNK in the context of post-thrombectomy treatment in stroke patients.

The current phase III trial, IA rhtnk-TPA thrombolysis, has resulted in acute LVO thrombolysis after successful mechanical thromborectomy (Angel-TNK) and 255 people of an average age of approximately 72 years. Includes adults, most of whom had aerobic boric stroke.

This study, conducted at 19 centres in China, enrolled patients who achieved successful reperfusion (defined as Etici 2B50 to 3) and scored a National Health Stroke Scale Score of 2 or higher.

The researchers randomly assigned participants to receive standard medical care management that differs depending on a variety of factors. It received recombinant human TNK tissue type plasminogen activator (RHTNK-TPA) by thrombolysis of the reflector and IA thrombolysis for 4.5-24 hours from the start of spraying.

Huo said that China's guidelines for stroke management did not extend the time frame for IVT within 4.5 hours, thus excluded patients with IV thrombolysis (IVT) at the time of hospitalization.

Choosing TNK

The researchers chose TNK over alteplase because of the high specificity of fibrin, a good safety profile, and a better recurrence rate than alteplase.

The optimal dose of TNK for IA thrombolysis remains unknown, so experts recommended a maximum dose of 12.5 mg using half the standard intravenous dose of 0.125 mg/kg.

The main efficacy results of Angel-TNK achieved excellent 90-day results (MRS, 0-1). The majority of patients in the intervention group achieved this outcome than those who received standard treatment (40.5% vs. 26.4%, treatment efficacy, 1.44; 95% CI, 1.06-1.95; p = .02).

In particular, the incidence of symptomatic intracranial hemorrhage within 48 hours of treatment was not high in the intervention group. The IV TNK group was 5.6% and the standard medical management group was 6.2% (p = .92).

The 9-day mortality rate was similar between the two groups: 21.4% for IA TNK and 21.7% for treatment (p = .39). Huo said his team will follow the study participants to assess the outcomes over the year.

Will the guidelines be changed first?

The findings of the study could lead to changes in treatment guidelines for stroke survivors after successful removal of latent agents, Huo said in a press release from the American Heart Association (AHA).

“Direct analysis of individual participant data from this and other trials (individual patient-level meta-analysis) should be conducted.

This study had several limitations, including its open label design, and there was no placebo control. Additionally, patients who have undergone periploque layer heparin, antiplatelets, or intravenous thrombolysis may be excluded, limiting the generalizability of the findings.

Furthermore, this study was conducted among patients in China, a population with a high prevalence of intracranial artery stenosis, and could affect the applicability of the results to other groups.

Huo also noted that doses of IA TNK are based on previous clinical experience and that it is necessary to study whether low doses are equally beneficial.

Encourage results

I will comment on the research of Medscape Medical NewsA neurologist at NYU Langone, New York, and a professor of neurology at NYU Grossman School of Medicine, NYU, said taking a stroke test that supports positive treatments is “always exciting.” Ta. TNK after endovascular therapy.

One reason for this approach was that it provided improved clinical outcomes without increased symptomatic bleeding, and that “additional lytic drugs help to replicate small vessels distal to the major occlusion,” according to AHA Stroke Ishida, who is also a member of Systems of Care, said. Advisory Group.

Effective treatment for extended time frames (in this case, 4.5-24.0 hours after the onset of stroke is also “particularly encouraging,” Ishida said. “This will allow for more effective treatments. You can help people.

The study received funding from recomgen Pharmaceutical Co., Ltd., a Chinese Sidiazean pharmaceutical company.