Tenecteplase Before EVT in Basilar Occlusion

Intravenous tenecteplase before endovascular thrombectomy (EVT) did not significantly improve functional independence at 90 days compared with EVT alone in patients with moderate to severe basilar artery occlusion who presented 4.5 to 24 hours after stroke onset. The ATTENTION LATE randomized clinical trial was published in JAMA.

The open-label trial used blinded outcome assessment and included 330 patients at 40 stroke centers in China. Participants arrived directly at EVT-capable centers and had a National Institutes of Health Stroke Scale score of at least 10. Investigators assigned 166 patients to intravenous tenecteplase at 0.25mg/kg (maximum, 25mg) before EVT and 164 to EVT alone. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0 to 2 at 90 days.

Of the 329 patients completing 90-day follow-up, 50 of 165 patients (30%) in the tenecteplase group and 50 of 164 (30%) in the EVT-only group achieved functional independence. The adjusted rate ratio was 0.92 (95% CI, 0.67-1.25), with a risk difference of −0.18 percentage points (95% CI, −10.13 to 9.76 percentage points).

Symptomatic intracranial hemorrhage occurred in 8 patients (5%) receiving tenecteplase before EVT and 6 (4%) receiving EVT alone. Ninety-day mortality was 40% (66 patients) and 43% (70 patients), respectively. The abstract described mortality as similar between groups and did not provide a comparative effect estimate for symptomatic intracranial hemorrhage.

The investigators concluded that adding tenecteplase before EVT did not improve functional outcomes in patients admitted directly to EVT-capable centers within the studied time window. The reported results are limited to patients admitted directly to EVT-capable centers.

Source: Li R, Yao X, Nogueira RG, et al. Tenecteplase before thrombectomy at 4.5 to 24 hours for basilar artery occlusion: the ATTENTION LATE randomized clinical trial. JAMA. Published online September 23, 2026. doi:10.1001/jama.2026.15496