To investigate in routine care the efficacy and safety of IV thrombolysis (IVT) with tenecteplase prior to mechanical thrombectomy (MT) in patients with large vessel occlusion acute ischemic strokes (LVO-AIS), either secondarily transferred after IVT or directly admitted to a comprehensive stroke center (CSC).

We retrospectively analyzed clinical and procedural data of patients treated with 0.25 mg/kg tenecteplase within 270 minutes of LVO-AIS who underwent brain angiography. The main outcome was 3-month functional independence (modified Rankin Scale score ≤2). Recanalization (revised Treatment in Cerebral Ischemia score 2b–3) was evaluated before (pre-MT) and after MT (final).

We included 588 patients (median age 75 years [interquartile range (IQR) 61–84]; 315 women [54%]; median NIH Stroke Scale score 16 [IQR 10–20]), of whom 520 (88%) were secondarily transferred after IVT. Functional independence occurred in 47% (n = 269/570; 95% confidence interval [CI] 43.0–51.4) of patients. Pre-MT recanalization occurred in 120 patients (20.4%; 95% CI 17.2–23.9), at a similar rate across treatment paradigms (direct admission, n = 14/68 [20.6%]; secondary transfer, n = 106/520 [20.4%]; p > 0.99) despite a shorter median IVT to puncture time in directly admitted patients (38 [IQR 23–55] vs 86 [IQR 70–110] minutes; p < 0.001). Final recanalization was achieved in 492 patients (83.7%; 95%CI 80.4–86.6). Symptomatic intracerebral hemorrhage occurred in 2.5% of patients (n = 14/567; 95% CI 1.4–4.1).

Tenecteplase before MT is safe, effective, and achieves a fast recanalization in everyday practice in patients secondarily transferred or directly admitted to a CSC, in line with published results. These findings should encourage its wider use in bridging therapy.

This study provides Class IV evidence that tenecteplase within 270 minutes of LVO-AIS increases the probability of functional independence.

在常规护理中研究在机械取栓术 (MT) 前使用替奈普酶静脉溶栓 (IVT) 对大血管闭塞性急性缺血性卒中 (LVO-AIS) 患者的疗效和安全性，这些患者在 IVT 后二次转移或直接入院综合治疗。中风中心（CSC）。

我们回顾性分析了接受脑血管造影的 LVO-AIS 后 270 分钟内接受 0.25 mg/kg 替奈普酶治疗的患者的临床和操作数据。主要结果是 3 个月的功能独立性（改良 Rankin 量表评分≤2）。在 MT 之前（MT 前）和 MT 之后（最终）评估再通（修订后的脑缺血治疗评分 2b-3）。

我们纳入了 588 名患者（中位年龄 75 岁 [四分位距 (IQR) 61-84]；315 名女性 [54%]；中位 NIH 中风量表评分 16 [IQR 10-20]），其中 520 名 (88%) 是继发性IVT 后转移。47%（n = 269/570；95% 置信区间 [CI] 43.0–51.4）的患者出现功能独立。120 名患者 (20.4%; 95% CI 17.2–23.9) 发生了 MT 前再通，不同治疗模式的发生率相似（直接入院，n = 14/68 [20.6%]；二次转移，n = 106/520 [ 20.4%]；p > 0.99）尽管直接入院患者的 IVT 中位穿刺时间较短（38 [IQR 23-55] 对 86 [IQR 70-110] 分钟；p< 0.001)。492 名患者实现了最终再通（83.7%；95%CI 80.4–86.6）。2.5% 的患者出现有症状的脑出血（n = 14/567；95% CI 1.4-4.1）。

与已发表的结果一致，MT 之前的替奈普酶是安全、有效的，并且在二次转移或直接入院 CSC 的患者的日常实践中实现了快速再通。这些发现应该鼓励其在桥接疗法中的更广泛应用。

这项研究提供了 IV 类证据，证明 LVO-AIS 后 270 分钟内的替奈普酶增加了功能独立的可能性。