Tenecteplase benefit after stroke thrombectomy persists at one year

Clinical takeaway: In selected patients treated for a large-vessel ischemic stroke, giving intra-arterial tenecteplase after successful thrombectomy may improve the chance of an excellent long-term recovery. The evidence supports further evaluation by stroke teams, but conflicting trial results leave its routine use uncertain.

Reopening a blocked artery does not always restore blood flow throughout the affected brain tissue. In the ANGEL-TNK trial, researchers tested whether delivering tenecteplase directly into a cerebral artery after successful thrombectomy could improve recovery. A new analysis suggests that the benefit seen at 90 days persisted at one year.

The trial enrolled 255 adults at 19 centers in China. All had an anterior circulation large-vessel occlusion, presented 4.5 to 24 hours after they were last known to be well, underwent successful thrombectomy, and had not received intravenous thrombolysis. They were assigned to intra-arterial tenecteplase or standard medical treatment. Of the 255 patients enrolled, 241 completed one-year follow-up.

At one year, 45.8% of patients given tenecteplase had little or no disability, compared with 28.1% of those given standard treatment. That is about 18 more patients with little or no disability per 100 treated.

Broader measures of disability did not show statistically significant differences. These included functional independence, which also counts patients who can manage their own affairs despite some limitations. Mortality was similar between groups, at approximately one-third of patients.

The findings raise a practical question for stroke teams: after reopening a blocked artery, could treatment delivered before the procedure ends improve a patient’s long-term recovery? Other trials have produced conflicting results, so further research is needed to identify which patients are most likely to benefit.

Source: Tong X, et al. (2026 Sep 28) JAMA. Intra-Arterial Tenecteplase After Endovascular Thrombectomy for Acute StrokeOne-Year Outcomes of the ANGEL-TNK Randomized Clinical Trial