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Los Angeles, Feb. 7, 2025 – A new stroke treatment approach that combines the removal of a large brain artery clot with the clot-dissolving drug tenecteplase has shown promising results in improving patient recovery. Preliminary findings from a study presented at the American Stroke Association’s International Stroke Conference 2025 suggest that stroke survivors treated with this method were more likely to achieve better functional outcomes 90 days post-stroke than those receiving standard clot removal alone.
The conference, held from Feb. 5-7, 2025, in Los Angeles, is a premier gathering of researchers and clinicians dedicated to advancing stroke and brain health science.
New Treatment Approach
Approximately one in five ischemic strokes occur due to large vessel occlusions, where a clot obstructs a major brain artery. The standard treatment involves endovascular therapy, a minimally invasive procedure that removes the clot via a catheter or stent to restore blood flow. However, while this procedure successfully removes blockages in large arteries, smaller blood vessels may remain impaired, affecting overall recovery.
Dr. Xiaochuan Huo, lead author of the study and director of the neurological disease center at Beijing Anzhen Hospital in China, explained the rationale for the study: “Endovascular treatment can help restore blood flow in a blocked large blood vessel. However, it might not improve blood flow in the smaller vessels and microcirculation in the area. This clinical trial tests whether delivering tenecteplase directly into the affected artery after endovascular treatment can break up blood clots in the small vessels and improve blood flow, reducing the amount of brain tissue that lacks blood supply.”
Study Findings
Conducted at 19 centers in China, the study evaluated the safety and effectiveness of intra-arterial tenecteplase administered near the site of clot removal. The clinical trial involved 255 stroke patients treated between 4.5 and 24 hours after they were last observed to be well. Patients were randomly assigned to either standard medical care following clot removal or an additional tenecteplase injection.
Key findings from the study include:
- Stroke survivors were 44% more likely to have an excellent recovery (modified Rankin score 0-1) after 90 days if they received tenecteplase compared to those who received standard care alone (40.5% vs. 26.4%).
- Rates of brain bleeding within 48 hours of treatment were comparable between the tenecteplase group (5.6%) and the standard treatment group (6.2%).
- Mortality rates within 90 days were also similar in both groups (21.4% vs. 21.7%).
Dr. Huo emphasized the potential of the findings: “Intra-arterial tenecteplase after successful thrombectomy could improve the percentage of people with an excellent outcome. It could also improve the rate of large vessel occlusion stroke survivors who can return to society and live independently.”
Future Implications
The research team will continue monitoring participants to assess their one-year recovery outcomes. Dr. Huo indicated that these findings may eventually influence clinical guidelines for stroke management but noted that further studies and meta-analyses are necessary before formal recommendations can be made.
The study did not include patients who received intravenous clot-busting drugs or anticoagulants during their endovascular procedures. As a result, the benefits observed in this study may not apply to those who undergo different initial treatments.
Study Background
The ANGEL-TNK study enrolled 255 participants (mean age 70, 44.7% female) across 19 centers in 13 provinces of China. All patients had experienced ischemic strokes due to a large artery blockage in the anterior circulation and had successful blood flow restoration through clot removal. Exclusion criteria included prior treatment with intravenous clot-busting drugs, which are typically administered within 4.5 hours of stroke onset.
Primary effectiveness was measured using the modified Rankin Scale, with an emphasis on the proportion of patients achieving no or minimal disability 90 days post-treatment. Safety assessments focused on the incidence of brain hemorrhage within 48 hours and overall mortality within 90 days.
Disclaimer:
This study represents preliminary findings and has not yet resulted in changes to established stroke treatment guidelines. Further research is necessary to confirm the safety and efficacy of intra-arterial tenecteplase following thrombectomy. Patients should consult their healthcare providers before considering any changes in stroke treatment protocols.
Provided by the American Heart Association.
