Rescue treatment for medium vessel occlusion by intra-arterial tenecteplase: the RESCUE-TNK randomized clinical trial.

In acute ischemic stroke due to medium vessel occlusion, intra-arterial tenecteplase achieved successful reperfusion in 61.0% (25/41) versus 28.2% (11/39) with standard care.

• Why it matters: Medium vessel occlusion needs targeted reperfusion strategies, and it is unclear whether intra-arterial tenecteplase can improve successful reperfusion without added safety risk.
• What they did: In a phase 2, prospective, randomized, open-label, blinded-endpoint multicentre trial, 80 patients with MeVO were assigned 1:1 to intra-arterial tenecteplase or standard care, comparing successful reperfusion.
• The result: Successful reperfusion was linked to higher odds with tenecteplase (unadjusted odds ratio 3.98, 95% CI 1.56–10.16; P=0.004), while symptomatic intracranial hemorrhage within 24 h was similar, supporting comparable safety.

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