Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment (BAO-TNK).

Authors

• Rahul R Karamchandani
• Dylan N Wolman
• Tyler M Bielinski
• Nitin Goyal
• Jeremy B Rhoten
• Mahesh V Jayaraman
• Christian T Sidebottom
• Bradley A Gross
• Alhamza R Al-Bayati
• Mohamed F Doheim
• Matthew K Tobin
• Anoop Chinthala
• Avi Gajjar
• Justin Mascitelli
• Matthew R Webb
• Jan-Karl Burkhardt
• Kyle W Scott
• Visish Srinivasan
• Daniel Tonetti
• Manisha Koneru
• David J Altschul
• Dhrumhil Vaishnav
• Sumeet Multani
• Thana Theofanis
• William J Ares
• Je Yeong Sone
• Ramin Zand
• Sasan Bahrami
• Jiang Li
• Gary Defilipp
• Dale Strong
• Radmehr Torabi
• Krisztina Moldovan
• Kelsey E Kline
• Clemens M Schirmer
• Raul G Nogueira
• Alexandra R Paul
• Bradley N Bohnstedt
• Philipp Hendrix

Publication/Presentation Date

3-1-2026

Abstract

OBJECTIVE: To compare the effectiveness and safety of tenecteplase (TNK) versus alteplase (TPA) in patients with basilar artery occlusion prior to endovascular treatment (EVT).

METHODS: In this retrospective multicenter study (BAO-TNK), we analyzed consecutive BAO patients from 14 U.S. stroke systems who received TNK or TPA within 4.5 h of last known well and were referred for EVT (01/2020-08/2024). Multivariable logistic regression models were adjusted for age, sex, NIH Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), last-known-well-to-door time, and stroke etiology. Outcomes included 90-day modified Rankin Scale (mRS), reperfusion rates, and intracranial hemorrhage (ICH) per Heidelberg classification.

RESULTS: Of 163 BAO patients, 75 (46.0%) received TNK and 88 (54.0%) received TPA. Rates of 90-day good functional outcome (mRS 0-3) were comparable between groups (TNK: 61.8% vs. TPA: 48.8%, adjusted odds ratio [aOR] 1.372, 95% CI 0.616-3.054, p = 0.439). No significant differences were observed in rates of pre-thrombectomy early reperfusion (18.7% vs. 14.8%, aOR 0.933, 95% CI 0.369-2.359, p = 0.884), post-thrombectomy final reperfusion (97.3% vs. 92.0%, aOR 2.133, 95% CI 0.376-12.116, p = 0.393), 90-day mortality (32.4% vs. 39.5%, aOR 0.989, 95% CI 0.436-2.244, p = 0.979), or symptomatic ICH (4.0% vs. 4.5%, aOR 1.319, 95% CI 0.245-7.114, p = 0.747). Predictors of favorable outcome included younger age, lower NIHSS, higher pc-ASPECTS, shorter LKW-to-puncture time, and non-atherothrombotic stroke etiology.

INTERPRETATION: In BAO stroke, TNK and TPA administered within 4.5 h pre-EVT were associated with similar functional outcomes, reperfusion success and hemorrhage rates.

Volume

13

Issue

3

First Page

574

Last Page

580

ISSN

2328-9503

Published In/Presented At

Karamchandani, R. R., Wolman, D. N., Bielinski, T. M., Goyal, N., Rhoten, J. B., Jayaraman, M. V., Sidebottom, C. T., Gross, B. A., Al-Bayati, A. R., Doheim, M. F., Tobin, M. K., Chinthala, A., Gajjar, A., Mascitelli, J., Webb, M. R., Burkhardt, J. K., Scott, K. W., Srinivasan, V., Tonetti, D., Koneru, M., … Hendrix, P. (2026). Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment (BAO-TNK). Annals of clinical and translational neurology, 13(3), 574–580. https://doi.org/10.1002/acn3.70240

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

41236051

Department(s)

Administration and Leadership

Document Type

Article