Methodology: 4.5/5
Usefulness: 4/5
Miao Z, et al. JAMA. 2025 Aug 19;334(7):582-591. doi: 10.1001/jama.2025.10800.
Question and Methods: To compare clinical outcomes in patients with acute LVO for those who received intra-arterial tenecteplase after successful thrombectomy compared to those who received only standard medical management.
Findings: 40.5% in the intra-arterial tenecteplase group and 26.4% in the control met the primary endpoint was mRS score of 0-1 at 90 days.
Limitations: Limited generalizability of results due to many patients being excluded (those who received IV thrombolysis, peri-procedural IV heparin or anti-platelet use). No difference in any of the secondary outcomes; further research needed for confirmation of study results
Interpretation: Intra-arterial tenecteplase after successful thrombectomy had a greater likelihood of excellent neurological outcome at 90 days without increasing the risk of spontaneous intracranial hemorrhage or mortality and may be helpful as a rescue/salvage therapy in patients who have embolization of smaller clots after removal of larger clots during thrombectomy.
JC Supervisor: Dr. Ian Stiell
