Intra-arterial tenecteplase during thrombectomy for acute ischemic stroke: the BRETIS-TNK2 trial.

In the BRETIS-TNK2 phase 3 trial of acute ischemic stroke patients undergoing EVT within 24 hours, favorable 90-day mRS 0–2 occurred in 40.0% vs 46.8%.

• Why it matters: Intra-arterial tenecteplase during endovascular treatment may enhance first-pass recanalization and clear microcirculatory thrombi, but its clinical efficacy and safety remain uncertain.
• What they did: In a multicentre randomized adaptive-enrichment open-label study, 380 patients were assigned 1:1 to intra-arterial tenecteplase during EVT or EVT alone, with blinded endpoint assessment.
• The result: Primary functional outcomes were not improved: mRS 0–2 at 90 days was 40.0% vs 46.8% (unadjusted odds ratio 0.76, 95% CI 0.50–1.14, P=0.19), suggesting no benefit in this population.

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