Rescue treatment for medium vessel occlusion by intra-arterial tenecteplase: the RESCUE-TNK randomized clinical trial.
Zi-Ai Zhao, Shou-Chun Wang, Ming Wei et al.
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In 30 seconds
The RESCUE-TNK phase 2, multicentre randomised trial evaluated intra-arterial tenecteplase versus standard care in patients with acute ischaemic stroke caused by medium vessel occlusion. Among 80 randomised patients, successful reperfusion occurred in 61.0% (25/41) of the tenecteplase group and 28.2% (11/39) of controls (unadjusted odds ratio 3.98, 95% CI 1.56-10.16; P = 0.004). Symptomatic intracranial haemorrhage within 24 h was similar between groups. The findings indicate improved reperfusion with tenecteplase in this trial, while safety assessment remains based on a phase 2 study.
Key findings
- Successful reperfusion was achieved in 61.0% (25/41) with intra-arterial tenecteplase versus 28.2% (11/39) with standard care.
- The unadjusted odds ratio for successful reperfusion was 3.98 (95% CI 1.56-10.16; P = 0.004).
- Symptomatic intracranial haemorrhage within 24 h was similar between the tenecteplase and control groups.
Why it matters
Medium vessel occlusion is a cause of acute ischaemic stroke, and this trial found a higher rate of successful reperfusion with targeted intra-arterial tenecteplase than with standard care. Reperfusion is a clinically relevant treatment outcome, while the similar observed haemorrhage rates provide an initial safety signal. These results add evidence for further evaluation of this approach.
What to keep in mind
This was a phase 2 trial with 80 patients; the abstract does not establish safety or clinical benefit beyond the reported reperfusion outcome.