Intra-Arterial Tenecteplase After Successful Thrombectomy Improves Functional Outcomes in People with Large Vessel Occlusion

Adjunct intra-arterial TNKase (tenecteplase; Genentech, South San Francisco, CA) was associated with significant improvements in 90-day functional outcomes in individuals with acute ischemic stroke due to large vessel occlusion (LVO) presenting 4.5 to 24 hours prior to randomization who had already undergone successful endovascular thrombectomy. In study results published in JAMA, participants who received intra-arterial TNKase treatment were more likely to achieve an excellent functional outcome as compared with those who received standard medical treatment. The findings suggest that intra-arterial thrombolysis could serve a potential role as a complement to mechanical thrombectomy.

ANGEL-TNK (NCT05624190) was a phase 4, prospective, open-label, blinded end point, randomized clinical trial that was conducted across 19 centers in China. The study included 256 participants who presented with anterior circulation LVO stroke between 4.5 and 24 hours after symptom onset and had successful reperfusion following thrombectomy (defined as an expanded treatment in cerebral infarction [eTICI] score of ≥2b50). Participants were randomized 1:1 to receive either intra-arterial TNKase .125 mg/kg to a maximum of 12.5 mg or standard medical management following the Chinese Stroke Association’s guidelines.

In terms of results, the study met its primary end point at 90 days after randomization. Compared with those treated with standard medical management, participants who were treated with TNKase were more likely to achieve an excellent functional outcome as defined as a modified Rankin Scale (mRS) score of 0 to 1.

• 40.5% (n=51) of participants in the TNKase achieved an excellent functional outcome compared with 26.4% (n=34) of those in the standard medical management group (relative risk, 1.44; 95% CI, 1.06 to 1.95; P=.02).
• There were no statistically significant differences between the 2 treatment groups in any of the 7 prespecified secondary outcomes, which included changes in mRS score, changes in National Institutes of Health Stroke Scale (NIHSS) score, infarct core volume changes, and functional independence.
• Safety outcomes were similar between the 2 groups: intracranial hemorrhage within 48 hours and death within 90 days occurred in 24.6% (n=27) and 21.4% (n=31) of those treated with TNKase and 27.9% (n=36) and 21.7% (n=28) of those who received standard medical management, respectively.