Optimizing Acute Ischemic Stroke Outcomes: The Role of Tenecteplase Before Mechanical Thrombectomy

• Published in: Clinical therapeutics 2024-11, Vol.46 (11), p.e10-e20
• Main Authors: Haj Mohamad Ebrahim Ketabforoush, Arsh, Hosseinpour, Ali, Habibi, Mohamad Amin, Ariaei, Armin, Farajollahi, Maedeh, Chegini, Rojin, Mirzaasgari, Zahra
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Amino acids; Bats; Blood clots; Clinical outcomes; Clinical trials; Cost analysis; Dosage; Drug dosages; Fibrin; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Genetic engineering; Humans; Ischemia; Ischemic Stroke - drug therapy; Ischemic Stroke - therapy; Mechanical thrombectomy; Mortality; Neuroimaging; Proteins; Reperfusion; Stroke; Tenecteplase; Tenecteplase - administration & dosage; Tenecteplase - therapeutic use; Thrombectomy - methods; Thrombolysis; Thrombolytic drugs; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Veins & arteries
• ISSN: 0149-2918; 1879-114X; 1879-114X
• DOI: 10.1016/j.clinthera.2024.08.014

Acute ischemic stroke (AIS) is a life-threatening condition demanding prompt reperfusion to salvage brain tissue. Thrombolytic drugs, like tenecteplase (TNK), offer clot dissolution, but time constraints and contraindications limit their use. Mechanical thrombectomy (MT) revolutionized AIS treatment, especially for large vessel occlusions (LVO). Recent evidence suggests that administering TNK before MT improves recanalization and outcomes, challenging the dominance of alteplase. Relevant articles focusing on TNK before MT were retrieved from PubMed, Scopus, and Web of Science, looking for randomized controlled trials (RCT), clinical trials, and meta-analyses in humans until 2024. TNK, a genetically engineered thrombolytic, exhibits superior fibrin specificity and a longer half-life than alteplase. Clinical trials comparing TNK and alteplase before MT showcase enhanced recanalization, functional outcomes, and safety with TNK. Advanced neuroimaging aids patient selection, though its cost-effectiveness warrants consideration. Dosing studies favor a 0.25 mg/kg dose for efficacy and reduced complications. Clinical guidelines from various associations acknowledge TNK's potential as an alteplase alternative for AIS treatment, particularly for LVOs eligible for thrombectomy. In conclusion, TNK emerges as a promising option for bridging therapy in AIS, displaying efficacy and safety benefits, especially when administered before MT. Its fibrin specificity, longer half-life, and potential for improved outcomes position TNK as a viable alternative to alteplase, potentially transforming the landscape of AIS treatment strategies. While limitations like small sample sizes and variations in protocols exist, future research should focus on large-scale RCT, subgroup analyses, and cost-effectiveness evaluations to further elucidate TNK's role in optimizing AIS management.