{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:04:03Z","timestamp":1789380243772,"version":"build-2803163510"},"reference-count":26,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"China Shijiazhuang Pharmaceutical Company Recomgen Pharmaceutical (Guangzhou) Co, Ltd."}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endovascular thrombectomy achieves macroreperfusion in large vessel occlusion (LVO) stroke, but only one-quarter of patients had excellent functional outcome. Adjunct intra-arterial (IA) tenecteplase could further improve the treatment effect, yet its efficacy across internal carotid artery (ICA) versus middle cerebral artery (MCA) M1\/M2 occlusion remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether IA tenecteplase improves 90-day functional outcomes in LVO patients stratified by occlusion site (ICA, MCA M1, MCA M2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prespecified secondary analysis of the ANGEL-TNK trial (multicenter, randomized, open-label, blinded endpoint) in 19 Chinese stroke centers. Participants were enrolled who had anterior circulation LVO, 4.5\u201324\u2009hours from symptom onset, and CT angiography (CTA)\/magnetic resonance angiography (MRA)-proven ICA, M1, or M2 occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Randomization (1:1) to IA tenecteplase (0.125\u2009mg\/kg) or standard medical management after expanded Thrombolysis in Cerebral Infarction (eTICI) 2b50-3 reperfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>The primary outcome was the rate of 90-day modified Rankin Scale (mRS) 0\u20131.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 256 patients in the trial, including 71 (27.7%) ICA, 122 (47.6%) MCA M1, and 62 (24.2%) MCA M2. ICA occlusion patients treated with IA tenecteplase had higher rates of 90-day mRS 0\u20131 (39.4% vs 13.2%; relative risk (RR) 2.99; 95%\u2009CI 1.51 to 5.96; p=0.002) and mRS 0\u20133 (54.5% vs 42.1%; RR 1.30; p=0.048) versus controls, with a significant shift toward better mRS scores (median 3 (IQR 1\u20134) vs 4 (2\u20136); odds ratio (OR) 2.26; p&lt;0.001). Post hoc analysis showed higher eTICI progression in ICA patients (51.5%) versus MCA M1 (37.9%) and M2 (25.7%). IA tenecteplase had a lower any intracranial hemorrhage within 48 hours in ICA patients (15.2% vs 39.5%; RR 0.38; p&lt;0.001) compared with standard medical management. No significant benefits were observed in the MCA M1\/M2 subgroups, and interaction effects were significant between ICA and MCA segments for functional outcomes and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>IA tenecteplase had a better functional outcome and lower hemorrhage risk in ICA occlusion compared with standard medical management but not in MCA M1\/M2. Occlusion site is a critical determinant of response to IA tenecteplase. A pooled analysis of IA tenecteplase stratified by occlusion site strata is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2025-024129","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T07:05:35Z","timestamp":1761289535000},"page":"2004-2010","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Occlusion site and outcomes in intra-arterial tenecteplase after successful endovascular therapy: a secondary analysis of the ANGEL-TNK trial"],"prefix":"10.1136","volume":"18","clinical-trial-number":[{"clinical-trial-number":"nct05624190","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05499832","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05657470","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Shuo","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cerebral Vascular 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