BRIDGE-TNK
Trial question
What is the role of intravenous tenecteplase in patients with AIS due to large vessel occlusion?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 550
550 patients (230 female, 320 male).
Inclusion criteria: patients with AIS due to large vessel occlusion who had presented within 4.5 hours after onset.
Key exclusion criteria: contraindications to intravenous thrombolysis; receipt of intravenous thrombolysis before screening; ICH; any terminal disease with a life expectancy < 6 months; intravenous AVM or aneurysm; pregnancy or lactation.
Interventions
N=278 tenecteplase plus thrombectomy (intravenous tenecteplase 0.25 mg/kg, maximum dose of 25 mg, followed by endovascular thrombectomy).
N=272 thrombectomy alone (endovascular thrombectomy alone).
Primary outcome
Percentage of patients achieving functional independence at day 90
52.9%
44.1%
52.9 %
39.7 %
26.4 %
13.2 %
0.0 %
Tenecteplase plus
thrombectomy
Thrombectomy
alone
Significant
increase ▲
NNT = 11
Significant increase in the percentage of patients achieving functional independence at day 90 (52.9% vs. 44.1%; RR 1.18, 95% CI 1.01 to 1.39).
Secondary outcomes
No significant difference in mRS score at day 90 (44.9% vs. 39.4%; OR 1.16, 95% CI 0.94 to 1.43).
No significant difference in mRS score of 0 or 1 at day 90 (34.9% vs. 27.9%; RR 1.24, 95% CI 0.98 to 1.57).
Significant increase in successful reperfusion before thrombectomy (6.1% vs. 1.1%; RR 5.19, 95% CI 1.51 to 17.84).
Safety outcomes
No significant differences in death within 90 days, symptomatic ICH within 48 hours.
Conclusion
In patients with AIS due to large vessel occlusion who had presented within 4.5 hours after onset, tenecteplase plus thrombectomy was superior to thrombectomy alone with respect to the percentage of patients achieving functional independence at day 90.
Reference
Zhongming Qiu, Fengli Li, Hongfei Sang et al. Intravenous Tenecteplase before Thrombectomy in Stroke. N Engl J Med. 2025 May 21. Online ahead of print.
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