Objective:

To evaluate the efficacy of intravenous tenecteplase prior to endovascular treatment (EVT) in improving functional independence at 90 days in patients with acute ischemic stroke due to proximal middle cerebral artery occlusion, specifically those presenting 4.5 to 24 hours after last known well.

Key Findings:

• Functional independence at 90 days was 44% in the tenecteplase group and 43% in the EVT alone group, with an adjusted relative rate of 1.01 indicating no significant difference.
• Reperfusion rates prior to EVT were 10% for tenecteplase and 7% for EVT alone, but this did not lead to better functional outcomes, highlighting the need for further investigation.

Interpretation:

Intravenous tenecteplase prior to EVT did not improve functional outcomes in patients with acute ischemic stroke due to proximal middle cerebral artery occlusion, suggesting limited benefit of this approach in the studied population and emphasizing the need for further research in different settings.

Limitations:

• The trial may not have been powered to detect safety differences, and the sample size was near the minimum planned, limiting the ability to detect significant treatment effects.

Conclusion:

The study concluded that tenecteplase prior to EVT does not enhance the likelihood of functional independence in the specified patient population, highlighting the need for further research in different settings.