A clinical trial has demonstrated improved outcomes in patients who experienced strokes when intra-arterial tenecteplase was administered following mechanical clot removal, according to research presented at the American Stroke Association's International Stroke Conference 2025.
The multicenter ANGEL-TNK trial found that stroke survivors who received tenecteplase directly into the affected artery following endovascular treatment were 44% more likely to achieve an excellent outcome (modified Rankin Scale score = 0 to 1) at 90 days compared with standard care (40.5% vs 26.4%).
"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," lead study author Xiaochuan Huo, MD, PhD, Director of the Neurological Disease Center at Beijing Anzhen Hospital in China stated in a companion press release from the American Heart Association. "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," he added.
Researchers enrolled 255 participants across 19 centers in China between February 2023 and March 2024. All participants had experienced large vessel occlusions and underwent successful endovascular therapy between 4.5 and 24 hours following last known well time. The trial reported comparable safety outcomes between the groups, with similar rates of brain bleeds (5.6% for tenecteplase vs 6.2% for standard care) and 90-day mortality (21.4% vs 21.7%).
The researchers excluded patients who received intravenous clot-busting medications or anticoagulants during their endovascular procedures, potentially limiting the findings' applicability to this population. They are continuing to track participants for 1-year outcomes.
"We still need to directly analyze the individual data of participants in this and other trials—an individual meta-analysis—in order to release a high evidence-based recommendation," Dr. Huo noted.
The findings remain preliminary until published in a peer-reviewed journal. The study utilized a modified Rankin Scale with ratings from 0 (no disability) to 6 (death) to assess disability outcomes.
