{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:31:21Z","timestamp":1791570681325,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The first\u2010pass effect (FPE), defined as excellent reperfusion after a single attempt, is associated with improved outcomes in large vessel occlusion stroke. We evaluated whether intravenous tenecteplase (TNK) compared with alteplase (TPA) increases the likelihood of FPE in basilar artery occlusion (BAO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed 163 consecutive BAO patients treated with intravenous TNK or TPA within 4.5\u2009h of last known well across 14\u2009U.S. stroke systems (January 2020\u2013August 2024). Patients with early reperfusion (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927) or aborted procedures (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) were excluded. Multivariable ordinal and logistic regression identified predictors of FPE (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c\u20133) and modified FPE (mFPE, eTICI 2b\u20133), and FPE\/mFPE association with 90\u2010day outcomes (modified Rankin Scale [mRS] 0\u20133).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FPE occurred in 55 of 133 patients (41.4%) and was more frequent with TNK than TPA (51.7% vs 32.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). TNK was independently associated with higher odds of FPE (adjusted odds ratio [aOR] 2.37, 95% confidence interval [CI] 1.13\u20134.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023) and mFPE (aOR 2.74, 95% CI 1.20\u20136.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). Both FPE and mFPE were independently associated with ambulatory outcomes at 90\u2010days (FPE: aOR 2.94, 95% CI 1.18\u20137.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021; mFPE: aOR 5.11, 95% CI 1.81\u201314.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). TNK compared with TPA did not show an independent association with functional outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>In this multicenter BAO cohort, TNK increased the odds of achieving FPE compared with TPA. As FPE strongly predicted functional recovery, these findings suggest TNK may confer a reperfusion advantage with potential clinical benefit, although a direct outcome effect was not demonstrated. ANN NEUROL 2026;99:692\u2013704<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78102","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:41:41Z","timestamp":1764070901000},"page":"692-704","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Tenecteplase Versus Alteplase for First\u2010Pass Reperfusion in Basilar Artery Occlusion Stroke Thrombectomy"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5012-1690","authenticated-orcid":false,"given":"Dylan N.","family":"Wolman","sequence":"first","affiliation":[{"name":"Department of Radiology Warren Alpert School of Medicine at Brown University, Rhode Island Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul R.","family":"Karamchandani","sequence":"additional","affiliation":[{"name":"Department of Neurology Wake Forest University School of Medicine, Neurosciences Institute, Advocate Health  Charlotte NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Hemmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Geisinger  Danville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler M.","family":"Bielinski","sequence":"additional","affiliation":[{"name":"Geisinger College of Health Sciences  Scranton PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Neurology Semmes Murphey Clinic, University of Tennessee Health Sciences Center  Memphis TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy B.","family":"Rhoten","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Geisinger  Danville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh V.","family":"Jayaraman","sequence":"additional","affiliation":[{"name":"Department of Radiology Warren Alpert School of Medicine at Brown University, Rhode Island Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian T.","family":"Sidebottom","sequence":"additional","affiliation":[{"name":"Department of Neurology Semmes Murphey Clinic, University of Tennessee Health Sciences Center  Memphis TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhamza R.","family":"Al\u2010Bayati","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8279-5078","authenticated-orcid":false,"given":"Mohamed F.","family":"Doheim","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5717-5133","authenticated-orcid":false,"given":"Matthew K.","family":"Tobin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop","family":"Chinthala","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avi","family":"Gajjar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albany Medical Center  Albany NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Mascitelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Texas Health Science Center at San Antonio  San Antonio TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Texas Health Science Center at San Antonio  San Antonio TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan\u2010Karl","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania Health System  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle W.","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania Health System  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Visish","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania Health System  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Cooper University Health Care  Camden NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5012-6793","authenticated-orcid":false,"given":"Manisha","family":"Koneru","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Cooper University Health Care  Camden NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5130-1378","authenticated-orcid":false,"given":"David J.","family":"Altschul","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Montefiore Medical Center, Albert Einstein College of Medicine  Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhrumhil","family":"Vaishnav","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Montefiore Medical Center, Albert Einstein College of Medicine  Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeet","family":"Multani","sequence":"additional","affiliation":[{"name":"Main Line Health\u2010Jefferson Neurosurgery  Paoli PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thana","family":"Theofanis","sequence":"additional","affiliation":[{"name":"Main Line Health\u2010Jefferson Neurosurgery  Paoli PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Ares","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Northshore University HealthSystem  Evanston IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Je Yeong","family":"Sone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Northshore University HealthSystem  Evanston IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-0094","authenticated-orcid":false,"given":"Ramin","family":"Zand","sequence":"additional","affiliation":[{"name":"Department of Neurology College of Medicine, The Pennsylvania State University  Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasan","family":"Bahrami","sequence":"additional","affiliation":[{"name":"Department of Neurology College of Medicine, The Pennsylvania State University  Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Molecular and Functional Genomics Weis Center for Research  Danville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Defilipp","sequence":"additional","affiliation":[{"name":"Charlotte Radiology Advocate Health  Charlotte NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Strong","sequence":"additional","affiliation":[{"name":"Information and Analytics Services, Advocate Health  Charlotte NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radmehr","family":"Torabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Warren Alpert School of Medicine at Brown University, Rhode Island Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztina","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Warren Alpert School of Medicine at Brown University, Rhode Island Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens M.","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Geisinger  Danville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra R.","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albany Medical Center  Albany NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley N.","family":"Bohnstedt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0017-5049","authenticated-orcid":false,"given":"Philipp","family":"Hendrix","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Geisinger  Danville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000202582.29510.6b"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.049924"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00483-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01820-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209249"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2206317"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207576"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241257223"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.025148"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.04.020"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030237"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562864221139595"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/15910199221149080"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2022.06.005"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/15910199211019174"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032810"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.040807"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.042691"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26547"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.70240"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014127"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.511162"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015492"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010049"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01142-X"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00062-023-01340-9"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00062-021-01085-3"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12353-w"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106847"},{"key":"e_1_2_10_33_1","article-title":"Intravenous thrombolysis before endovascular treatment in acute vertebrobasilar occlusions: pooled analysis of the French and German stroke registries","author":"Pop R","year":"2025","journal-title":"Eur Stroke J"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.043777"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716405"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221150022"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2023-020117"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2024-021654"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00062-020-00964-5"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2016-012721"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ana.78102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.78102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T15:36:31Z","timestamp":1772984191000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.78102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ana.78102"],"URL":"https:\/\/doi.org\/10.1002\/ana.78102","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"assertion":[{"value":"2025-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}