Methodology: 4/5
Usefulness: 4/5
Qiu Z, et al. N Engl J Med. 2025 Jul 10;393(2):139-150. doi: 10.1056/NEJMoa2503867.
Question and Methods: This multi-center, open-label RCT of 550 patients in China with acute ischemic stroke due to large vessel occlusion presenting within 4.5 hours compared 90-day functional independence between patients receiving tenecteplase + endovascular thrombectomy (EVT) vs. EVT treatment alone.
Findings: Functional independence at 90 days was achieved in 52.9% of patients in the tenecteplase + EVT group and in 44.1 % of patients in the EVT-alone group (unadjusted risk ratio 1.20, 1.01-1.43; P = 0.04).
Limitations: The major limitations include it being an open-label study and it being underpowered due to lower observed effect size.
Interpretation: Patients presenting with acute ischemic stroke due to large vessel occlusion within 4.5 hours would still benefit from IV thrombolytics with tenecteplase prior to EVT as supported by current guidelines, though more studies in North America should be completed to confirm this.
JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy
For previous posts about Stroke, please click HERE
