# Tenecteplase for Ischemic Stroke due to Large Vessel Occlusion at 4.5 to 24 Hours: A Meta‐Analysis of Randomized Controlled Trials

## TL;DR

This study finds that using tenecteplase for stroke patients up to 24 hours after symptoms start is effective and safe.

## Contribution

The study provides the first meta-analysis evaluating tenecteplase in the 4.5 to 24-hour time window for large vessel occlusion stroke.

## Key findings

- Tenecteplase improved functional outcomes (mRS 0–1) at 90 days compared to control.
- Tenecteplase increased recanalization rates without significant safety issues.
- No significant differences were found in mortality or hemorrhage between groups.

## Abstract

Whether to use tenecteplase for acute ischemic stroke patients in the extended window has so far been little studied.

In this meta‐analysis, we included all the randomized controlled trials comparing tenecteplase with control at 4.5 to 24 h after the last known well of acute ischemic stroke with large vessel occlusion. A systematic search was performed in PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials databases, up to 12th June, 2024. Our primary outcome was an excellent functional outcome with a modified Rankin scale score (mRS) of 0–1 at 90 days. Our safety outcomes included mRS 5–6 at 90 days, mortality within 90 days, symptomatic intracranial hemorrhage and parenchymal hematoma Type 2.

Ultimately, three studies involving 1198 patients were included in the pooled analysis, where tenecteplase exhibited a higher rate of mRS 0–1 at 90 days (OR, 1.36; 95%CI, 1.07–1.75; p = 0.01) and recanalization (OR, 3.30; 95%CI, 1.59–6.84; p = 0.001). For other outcomes, no significant differences were found between groups.

This meta‐analysis of randomized controlled trials manifested that tenecteplase within a 4.5‐ to 24‐h time window of large vessel occlusion stroke was superior to control for an excellent functional outcome (mRS 0–1) without safety concerns.

Question: Is it safe and effective to use tenecteplase for acute ischemic stroke patients beyond 4.5 h?

Finding: This meta‐analysis of randomized controlled trials manifested that tenecteplase administered within 4.5 to 24 h for large vessel occlusion stroke was superior to control for an excellent functional outcome without safety concerns.