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TOPLINE
An analysis of the ANGEL-TNK trial showed that intra-arterial tenecteplase given after successful endovascular thrombectomy (EVT) was associated with better neurologic recovery than standard treatment at 1 year after anterior circulation large vessel occlusion, with no significant difference in mortality.
METHODOLOGY
- Researchers conducted a prespecified secondary analysis of the ANGEL-TNK trial, an open-label randomized clinical trial conducted across 19 comprehensive stroke centers in China.
- The study included 255 adults with anterior circulation large vessel occlusion who presented 4.5 to 24 hours after symptom onset or last seen well and did not previously receive intravenous thrombolysis. A total of 241 completed the 1-year follow-up.
- Following successful EVT (defined as an expanded Thrombolysis in Cerebral Infarction score of 2b50-3), participants were randomly assigned to receive standard treatment (n = 121) or intra-arterial tenecteplase (n = 120; maximum dose, 12.5 mg) in the cerebral vasculature.
- The primary outcome was excellent functional status (modified Rankin Scale [mRS] score, 0-1) at 1 year. Functional independence (mRS score, 0-2), independent ambulation (mRS score, 0-3), mRS shift, and mortality were assessed as secondary outcomes at 1 year.
TAKEAWAY
- The proportion of patients achieving excellent functional status at 1 year was greater in the intra-arterial tenecteplase group than in the standard treatment group (45.8% vs 28.1%; relative risk, 1.55; P = .03).
- mRS shift, functional independence, independent ambulation, and mortality at 1 year were not significantly different between the groups.
- Sensitivity analyses confirmed the primary findings.
IN PRACTICE
"During the 12-month follow-up of the ANGEL-TNK trial, the benefit of intra-arterial tenecteplase in addition to EVT for the primary outcome of excellent functional status was sustained at 12 months," the investigators wrote.
"[T]his sustained efficacy was achieved without increasing long-term mortality, reinforcing the long-term safety profile of low-dose intra-arterial tenecteplase," they added.
SOURCE
The study was led by Xin Tong, PhD, and Jin Bai, PhD, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. It was published online on September 28 as a Research Letter in JAMA.
LIMITATIONS
Primary outcome data were missing for 5.1% of participants. Data on quality of life and cause of death at 1 year were not captured.
DISCLOSURES
CSPC Recomgen Pharmaceutical (Guangzhou) Co, Ltd. funded the trial and supplied tenecteplase free of charge. Disclosure information for the study investigators is available in the original study publication.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
