Tenecteplase Is a Better Alternative to Alteplase for Patients With Large Vessel Occlusion Stroke Receiving Bridging Therapy

The past 5 years have seen a marked increase in the use of tenecteplase for stroke thrombolysis because randomized trials and observational studies have shown its superior safety and noninferiority compared with alteplase, especially for patients with large vessel occlusions (LVOs).(1) Over the same period, randomized trials have demonstrated the clinical benefits of endovascular thrombectomy (EVT) in patients with large ischemic core,(2-5) including those receiving bridging therapy (IV thrombolytic before EVT). Most studies with bridging therapy have used alteplase. A study by Gerschenfeld et al.(6) published in this issue of Neurology (R) compares tenecteplase with alteplase as a bridging thrombolytic in patients with large core anterior circulation strokes. Using data from the prospective ETIS and the retrospective TETRIS multicenter French stroke registries, they compared the efficacy of alteplase and tenecteplase before EVT in patients with a LVO. The patients included in the study were comparable with those enrolled in the large core trials (median age of 71 years, a median NIHSS of 19, 43% women, and 53% with a M1 occlusion).(2,3) Using propensity matching, they found that patients treated with tenecteplase had improved outcomes and lower mortality at 3 months.