Early Reperfusion in Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment.
Publication/Presentation Date
9-1-2026
Abstract
BACKGROUND: Timely reperfusion is a critical determinant of favorable outcomes in basilar artery occlusion (BAO) stroke. We aimed to examine whether the choice of thrombolytic agent predicts early reperfusion (ER) in BAO stroke managed with tenecteplase versus alteplase before endovascular treatment.
METHODS: This was a retrospective, multicenter US cohort of consecutive patients with BAO from 14 stroke centers treated with tenecteplase or alteplase within 4.5 hours of last known well before endovascular treatment. The primary end point was ER, defined as angiographic ER (expanded Thrombolysis in Cerebral Infarction grade 2b to 3 on the first diagnostic angiogram), or clinical ER, defined as substantial neurological improvement precluding endovascular treatment and a good functional outcome (modified Rankin Scale score 0-3).
RESULTS: Among 163 patients with BAO and a median last known well-to-needle time of 135 minutes (interquartile range, 100-193) and last known well-to-puncture time of 228 minutes (interquartile range, 166-307), ER was observed in 27 (16.6%) patients. Rates of ER were comparable between tenecteplase (14/75, 18.7%) and alteplase (13/88, 14.8%; adjusted odds ratio, 1.082 [95% CI, 0.444-2.631];
CONCLUSIONS: In BAO treated within 4.5 hours of last known well, tenecteplase and alteplase produced comparable early reperfusion rates. Achieving ER did not modify the association between thrombolytic agent and good functional outcome, consistent with rapid thrombectomy in patients with no ER.
Volume
6
Issue
5
First Page
002392
Last Page
002392
ISSN
2694-5746
Published In/Presented At
Wolman, D. N., Karamchandani, R. R., Darko, K., 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., … Hendrix, P. (2026). Early Reperfusion in Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment. Stroke (Hoboken, N.J.), 6(5), e002392. https://doi.org/10.1161/SVIN.126.002392
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42707799
Department(s)
Administration and Leadership
Document Type
Article