Clinical Report: Tenecteplase Fails to Boost EVT Outcomes

Overview

The TNK-PLUS trial found that intravenous tenecteplase prior to endovascular treatment did not improve functional independence at 90 days compared to endovascular treatment alone in patients with acute ischemic stroke.

Background

Acute ischemic stroke due to proximal middle cerebral artery occlusion presents significant treatment challenges. The use of thrombolytics like tenecteplase prior to endovascular treatment has been explored, but evidence supporting its efficacy remains inconclusive.

Data Highlights

Key Findings

• Functional independence at 90 days was 44% in the tenecteplase group versus 43% in the endovascular treatment alone group.
• The adjusted relative rate for functional independence was 1.01, indicating no significant difference between groups.
• Reperfusion prior to endovascular treatment occurred in 10% of patients receiving tenecteplase compared to 7% in the control group.
• Symptomatic intracranial hemorrhage within 36 hours occurred in 5% of the tenecteplase group and 3% in the control group, with inconclusive safety data.
• Median time from symptom onset to randomization was approximately 10 hours, with a 90-minute door-to-needle time for tenecteplase.
• Subgroup analyses did not reveal significant treatment-effect heterogeneity across various demographics and clinical characteristics.

Clinical Implications

The findings from the TNK-PLUS trial indicate that administering tenecteplase prior to endovascular treatment does not confer additional benefits in achieving functional independence.

Conclusion

The TNK-PLUS trial indicates that tenecteplase does not improve outcomes when given before endovascular treatment for acute ischemic stroke.

Related Resources & Content

1. JAMA, 2026 -- Intravenous Tenecteplase Prior to Endovascular Treatment for Ischemic Stroke at 4.5 to 24 Hours: The TNK-PLUS Randomized Clinical Trial
2. 2026 Guideline for the Early Management of Patients With AIS - Professional Heart Daily | American Heart Association
3. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke - PMC
4. Frontiers in Neurology — Transition to tenecteplase is associated with shorter door-to-puncture times: a retrospective study from the Lone Star Stroke consortium TNK registry
5. Frontiers in Neurology — Long-term outcomes of endovascular thrombectomy vs. medical care in patients with large ischemic stroke: a systematic review and meta-analysis of randomized controlled trials
6. conexiant — Tirofiban After Tenecteplase in Stroke
7. European Radiology — Economic Evaluation of CT Perfusion for Identifying Large Vessel Occlusion in Acute Ischemic Stroke Patients Prior to Endovascular Intervention: A Model-Based Analysis
8. Transition to tenecteplase is associated with shorter door-to-puncture times: a retrospective study from the Lone Star Stroke consortium TNK registry
9. Long-term outcomes of endovascular thrombectomy vs. medical care in patients with large ischemic stroke: a systematic review and meta-analysis of randomized controlled trials
10. 2026 Guideline for the Early Management of Patients With AIS - Professional Heart Daily | American Heart Association
11. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke - PMC
12. Intravenous Tenecteplase Prior to Endovascular Treatment for Ischemic Stroke at 4.5 to 24 Hours: The TNK-PLUS Randomized Clinical Trial | Trials | JAMA | JAMA Network
13. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection | New England Journal of Medicine
14. Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy | New England Journal of Medicine
15. BRIDGE-TNK: Tenecteplase Before Thrombectomy Improves Post Stroke Functional Outcomes - American College of Cardiology