Intra-arterial Tenecteplase for Acute Stroke After Successful Endovascular Therapy

作者：Zhongrong Miao, Gang Luo, Ligang Song, Dapeng Sun, Wenhuo Chen, Xiaoxi Yao, Yuesong Pan, Yaou Liu, Guangxiong Yuan, Changming Wen, Ming Wei, Xueli Cai, Qingcheng Yang, Zhiming Zhou, Mingze Chang, Guangxian Nan, Jing Wang, Guangyu Xiang, Li Zhou, Wen Gao, Hong Zhang, Jiheng Hao, Chenghua Xu, Yaxuan Sun, Tingyu Yi, Ganghua Feng, Hongxing Han, Feng Gao, Ning Ma, Dapeng Mo, Xuan Sun, Yiming Deng, Xu Tong, Xiaoqing Li, Baixue Jia, Bo Wang, Zijun He, Ming Yang, Xingquan Zhao, Xuelei Zhang, Longhui Zhang, Shuo Li, Xin Tong, Jing Jing, Yunyun Xiong, Tao Liu, Zixiao Li, Zeguang Ren, Yilong Wang, David S. Liebeskind, Tudor G. Jovin, Thanh N. Nguyen, Yongjun Wang, Liping Liu, Bernard Yan, Xiaochuan Huo, ANGEL-TNK Investigators, Bo Liu, Chen Yao, Dan Long, Fengjie Jie, Gaoting Ma, Han Zhao, Hang Yu, Hongyi Yan, Jian Hua Yan, Jianfeng Han, Jingjun Zhao, Juan Wang, Kangning Chen, Liyong Zhang, Qi Zhou, Wanru Wang, Wei Wu, Xiaoling Liao, Xinghua Lu, Xuewei Xie, Yayun Sheng, Yuhuan Chen, Zhe Zhang, Zhou Zhou · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.10800 · 被引用次数：58 · 研究领域：Acute Ischemic Stroke Management、Blood Coagulation and Thrombosis Mechanisms、Intracerebral and Subarachnoid Hemorrhage Research

IMPORTANCE: The role of intra-arterial tenecteplase for acute large vessel occlusion (LVO) stroke after successful endovascular therapy is uncertain. OBJECTIVE: To assess the efficacy and safety of intra-arterial tenecteplase in patients with successful endovascular therapy (defined as a score on the expanded Thrombolysis in Cerebral Infarction [eTICI] scale of 2b to 3) after endovascular therapy. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, open-label, blinded end point, randomized trial. Recruitment took place between February 16, 2023, and March 23, 2024, with final follow-up on July 4, 2024. The study was conducted across 19 centers in China. Patients with acute anterior circulation LVO treated between 4.5 and 24 hours from the time that the patient was last known to be well were included. INTERVENTION: After successful endovascular recanalization, defined as eTICI 2b or greater, patients were randomized to receive intra-arterial tenecteplase at 0.125 mg/kg (n = 126) or standard medical treatment (n = 129). MAIN OUTCOMES AND MEASURES: The primary end point was excellent outcome at 90 days, defined as modified Rankin Scale (mRS) score of 0 to 1 (range, 0 [no symptoms] to 6 [death]). There were a total of 7 secondary efficacy end points (mRS score of 0-1 at 90 days, mRS score at 90 days, mRS score of 0-2 at 90 days, mRS score of 0-3 at 90 days, National Institutes of Health Stroke Scale score of 0-1 or improved ≥10 points at 36 hours, European Quality of Life ...