Visual Summary of POST-TNK Trial
Objective:
To evaluate the efficacy and safety of intra-arterial tenecteplase in patients with large vessel occlusion stroke achieving near-complete to complete reperfusion after EVT.
Design & Participants:
- Investigator-initiated, randomized, open-label trial with blinded outcome assessment.
- Conducted at 34 hospitals in China.
- Included 540 patients with acute ischemic stroke due to proximal intracranial large vessel occlusion presenting within 24 hours of last known well.
- All patients achieved near-complete to complete reperfusion (eTICI score of 2c or 3) and had no prior intravenous thrombolysis.
Interventions:
Patients were randomized into two groups:
- Intervention Group: Intra-arterial tenecteplase at 0.0625 mg/kg (n = 269).
- Control Group: No intra-arterial thrombolysis (n = 271).
Primary Outcome:
Freedom from disability, defined as mRS score 0-1 at 90 days.
Secondary Outcomes:
- Mortality at 90 days.
- Symptomatic intracranial hemorrhage within 48 hours.
Results:
- Freedom from Disability (Primary Outcome):
- 49.1% (132/269) in the tenecteplase group vs. 44.1% (119/270) in the control group (adjusted RR: 1.15; 95% CI: 0.97-1.36; P = 0.11).
- Mortality at 90 Days:
- 16.0% in the tenecteplase group vs. 19.3% in the control group (adjusted hazard ratio [HR]: 0.75; 95% CI: 0.50-1.13; P = 0.16).
- Symptomatic Intracranial Hemorrhage:
- 6.3% in the tenecteplase group vs. 4.4% in the control group (adjusted RR: 1.43; 95% CI: 0.68-2.99; P = 0.35).
Conclusions:
Adjunctive intra-arterial tenecteplase did not significantly increase the likelihood of freedom from disability at 90 days in patients with large vessel occlusion stroke achieving near-complete to complete reperfusion after EVT. Further research is needed to assess its efficacy in this population.