Intra-arterial tenecteplase for acute basilar artery occlusion with sufficient recanalization after thrombectomy: the INSIST-IT randomized clinical trial.

Adjunctive intra-arterial tenecteplase after successful EVT in acute basilar artery occlusion did not improve 90-day independent ambulation (40.0% vs 50.0%).

• Why it matters: The benefit and safety of adding intra-arterial tenecteplase after adequate recanalization in acute BAO are uncertain, leaving clinicians without clear guidance.
• What they did: In a prospective, randomized, adaptive-enrichment, open-label, blinded-endpoint multi-center trial, 144 patients with BAO within 24 h who achieved successful reperfusion were assigned to tenecteplase (n=75) or standard medical therapy (n=69).
• The result: The trial stopped early for safety concerns and lack of efficacy; at 90 days, independent ambulation was not significantly different (OR 0.67; P=0.23), with similar sICH (6.2% vs 4.8%; P=0.73) and mortality (41.3% vs 26.5%; P=0.063).

AI summary of the abstract · may contain errors · not medical advice · read the paper.