{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:49:24Z","timestamp":1791532164380,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":["Brain and Behavior"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Posterior circulation ischemic stroke (PCIS) is associated with substantial morbidity and mortality, and the optimal intravenous thrombolytic strategy in this subgroup remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched databases for studies comparing intravenous tenecteplase with alteplase in adults with PCIS. The primary outcome was functional independence at 90 days (mRS 0\u20132). Secondary outcomes included other functional outcomes, reperfusion, hemorrhagic complications, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five studies involving 997 patients were included. Regarding efficacy outcomes, tenecteplase was associated with a significantly greater likelihood of achieving an ambulatory functional outcome at 90 days (mRS 0\u20133) [RR 1.29, 95% CI 1.03\u20131.60;\n                      <jats:italic>p =<\/jats:italic>\n                      0.02] and improved pre\u2010EVT perfusion [RR 2.18, 95% CI 1.06\u20134.46;\n                      <jats:italic>p =<\/jats:italic>\n                      0.03]. No significant differences were observed for excellent functional outcome (mRS 0\u20131) [RR 1.19, 95% CI 0.91\u20131.56;\n                      <jats:italic>p =<\/jats:italic>\n                      0.20], functional independence (mRS 0\u20132) [RR 1.10, 95% CI 0.89\u20131.37;\n                      <jats:italic>p =<\/jats:italic>\n                      0.39], or post\u2010EVT perfusion [RR 1.12, 95% CI 0.89\u20131.40;\n                      <jats:italic>p =<\/jats:italic>\n                      0.34]. Regarding safety outcomes, no significant differences were observed between tenecteplase and alteplase for symptomatic intracranial hemorrhage (sICH) [RR 0.89, 95% CI 0.36\u20132.22;\n                      <jats:italic>p =<\/jats:italic>\n                      0.81], any intracranial hemorrhage [RR 1.02, 95% CI 0.59\u20131.78;\n                      <jats:italic>p =<\/jats:italic>\n                      0.94], parenchymal hematoma [RR 0.76, 95% CI 0.24\u20132.38;\n                      <jats:italic>p =<\/jats:italic>\n                      0.64], or 90\u2010day mortality [RR 0.88, 95% CI 0.66\u20131.17;\n                      <jats:italic>p =<\/jats:italic>\n                      0.39].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tenecteplase may improve reperfusion and ambulatory recovery without increasing hemorrhagic complications or mortality compared with alteplase in PCIS, although larger PCIS\u2010specific studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71831","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:58:39Z","timestamp":1791529119000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of Intravenous Tenecteplase versus Alteplase in Posterior Circulation Ischemic Stroke: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1587-4320","authenticated-orcid":false,"given":"Shaheer Bin","family":"Shafiq","sequence":"first","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6076-3926","authenticated-orcid":false,"given":"Ammad","family":"Uddin","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6416-5610","authenticated-orcid":false,"given":"Muhammad","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5938-7297","authenticated-orcid":false,"given":"Ghulam Taha","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9895-7170","authenticated-orcid":false,"given":"Muhammad","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8471-4261","authenticated-orcid":false,"given":"Muhammad Junaid","family":"Razzak","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2873-9491","authenticated-orcid":false,"given":"Mominah","family":"Majid","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4928-0821","authenticated-orcid":false,"given":"Faisal","family":"Islam","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6855-4435","authenticated-orcid":false,"given":"Umer","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Dr Ishrat Ul Ibad Khan Institute of Dentistry, Ojha Campus Dow University of Health Sciences  Karachi Sindh Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Anwaar","family":"Uddin","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1817-7800","authenticated-orcid":false,"given":"Hasibullah","family":"Aminpoor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kabul University of Medical Sciences \u201cAbu Ali Ibn Sina\u201d  Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5578-2022","authenticated-orcid":false,"given":"Muhammad","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.70667"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s44197\u2010025\u201000453\u20103"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221150022"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.67888"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011520"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.120.034019"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2023.03713"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716405"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107985"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2017.08.003"},{"issue":"3","key":"e_1_2_11_12_1","first-page":"192","article-title":"Posterior Circulation Ischemic Stroke","volume":"112","author":"Go S.","year":"2015","journal-title":"Missouri Medicine"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/00185787241289296"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.70240"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2025.0210"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1102463"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(22)00124\u20107"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883\u2010026\u201004655\u20105"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/ecm2030037"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(24)00377\u20106"},{"key":"e_1_2_11_22_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. A.","year":"2014"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2021.10.027"},{"key":"e_1_2_11_24_1","first-page":"371","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page M. J.","year":"2021","journal-title":"BMJ"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209903"},{"key":"e_1_2_11_26_1","unstructured":"RoB 2: A Revised Cochrane Risk\u2010of\u2010Bias Tool for Randomized Trials. March 14 2026 Cochrane Bias."},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/17474930211046758"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2022\u20100499"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40120\u2010023\u201000530\u20104"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/09727531231193242"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(22)02600\u20109"},{"issue":"17","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1001\/jama.2024.14721","article-title":"Tenecteplase vs Alteplase for Patients With Acute Ischemic Stroke: The ORIGINAL Randomized Clinical Trial","volume":"332","author":"Wang Y.","year":"2024","journal-title":"JAMA"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.1449"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010008\u20100796\u20108"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.78102"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1386386"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1313"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71831","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.71831","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:58:41Z","timestamp":1791529121000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.71831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/brb3.71831"],"URL":"https:\/\/doi.org\/10.1002\/brb3.71831","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71831"}}