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SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1487711
Tenecteplase versus alteplase for intravenous thrombolysis of acute ischemic stroke patients with large vessel occlusion: a systematic review and meta-analysis
Provisionally accepted- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
Background Tenecteplase (TNK) was found non-inferior to alteplase (ALT) for acute ischemic stroke (AIS). We sought to further elucidate the efficacy and safety of intravenous TNK versus ALT for AIS patients with large vessel occlusion (LVO).Methods We systematically searched PubMed, Embase, Web of Science and https://clinicaltrials.gov/ until January 20, 2024 for randomized controlled clinical trials (RCTs) comparing TNK with ALT in AIS patients with LVO. The quality of the included studies was estimated by the Cochrane Risk of Bias Tool. The pooled analysis and publication bias were conducted using RevMan 5.3 and Stata 15. Risk ratios (RRs) with 95% confidence intervals (95% CIs) were reported for each outcome measure. The primary outcome was excellent neurological recovery which was defined as modified Rankin Scale score (mRS) of 0–1 at 90 days and safety outcomes included any parenchymal hematoma, symptomatic intracerebral hemorrhage and 3-month death.Results Five RCTs enrolling 1028 patients were included. There were no significant differences in terms of 90-day excellent neurological recovery (RR 1.18; 95% CI 1.00–1.40; P = 0.05), good neurological recovery (RR 1.18; 95% CI 0.90–1.54; P = 0.23), early neurological improvement (RR 1.00; 95% CI 0.57–1.77; P = 1.00) or successful reperfusion (RR 1.15; 95% CI 0.93–1.44; P = 0.20). In addition, no significant differences were observed in safety outcomes, including any parenchymal hematoma (RR 1.01; 95% CI 0.70–1.45; P = 0.98), symptomatic intracerebral hemorrhage (RR 1.14; 95% CI 0.62–2.10; P = 0.68), or 3-month mortality (RR 1.22; 95% CI 0.52–2.84; P = 0.65).Conclusion TNK is an alternative to ALT for thrombolysis in AIS patients with confirmed LVO, offering lower cost and easier administration without increasing safety concerns.
Keywords: tenecteplase, alteplase, ischemic stroke, Large vessel occlusion, Meta-analysis
Received: 18 Oct 2024; Accepted: 21 Feb 2025.
Copyright: © 2025 Yao, Wang, Wu, Zhu, Li, Tang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaogang Tang, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
Minghua Wu, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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