POST-TNK
Trial question
What is the role of adjunctive intra-arterial tenecteplase after endovascular reperfusion in patients with AIS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 539
539 patients (220 female, 319 male).
Inclusion criteria: patients with AIS due to large vessel occlusion presenting within 24 hours of time last known to be well who had achieved near-complete to complete reperfusion after endovascular thrombectomy.
Key exclusion criteria: prestroke disability; treatment with intravenous thrombolysis before endovascular thrombectomy.
Interventions
N=269 intra-arterial tenecteplase (receipt of endovascular treatment plus infusion of intra-arterial tenecteplase 0.0625 mg/kg, maximum dose 6.25 mg, for 10-15 minutes).
N=270 standard treatment (receipt of endovascular treatment without intra-arterial thrombolysis).
Primary outcome
Freedom from disability at day 90
49.1%
44.1%
49.1 %
36.8 %
24.6 %
12.3 %
0.0 %
Intra-arterial
tenecteplase
Standard
treatment
No significant
difference ↔
No significant difference in freedom from disability at day 90 (49.1% vs. 44.1%; RR 1.15, 95% CI 0.97 to 1.36).
Secondary outcomes
No significant difference in mRS score of 0-2 at day 90 (61.3% vs. 58.9%; RR 1.06, 95% CI 0.93 to 1.21).
No significant difference in improvement in NIHSS score at 5-7 days or discharge if earlier (53.2% vs. 43.1%; WR 1.19, 95% CI 0.97 to 1.46).
No significant difference in European QoL Five-Dimension Five-Level score at day 90 (43.6% vs. 37.7%; WR 1.2, 95% CI 0.95 to 1.52).
Safety outcomes
No significant differences in death within day 90, symptomatic ICH within 48 hours.
Significant difference in any radiologic ICH within 48 hours (36.6% vs. 27.3%).
Conclusion
In patients with AIS due to large vessel occlusion presenting within 24 hours of time last known to be well who had achieved near-complete to complete reperfusion after endovascular thrombectomy, intra-arterial tenecteplase was not superior to standard treatment with respect to freedom from disability at day 90.
Reference
Jiacheng Huang, Jie Yang, Chang Liu et al. Intra-Arterial Tenecteplase Following Endovascular Reperfusion for Large Vessel Occlusion Acute Ischemic Stroke: The POST-TNK Randomized Clinical Trial. JAMA. 2025 Feb 18;333(7):579-588.
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