{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:50:50Z","timestamp":1787064650814,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Recent studies suggest that the use of adjunctive intraarterial alteplase after mechanical thrombectomy (MT) may improve outcomes; however, there are limited data on the use of intraarterial tenecteplase, a newer-generation lytic, in this acute ischemic stroke patient population. Here, we evaluate the use of intraarterial tenecteplase in the ALLY pilot study (Adjunctive Intraarterial Tenecteplase Following Mechanical Thrombectomy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>ALLY was a prospective, single-center, nonrandomized pilot study assessing the feasibility and safety of intraarterial tenecteplase up to 4.5 mg in acute ischemic stroke-large vessel occlusion MT patients with incomplete recanalization. The primary safety end point was any intracranial hemorrhage and neurological worsening by \u22654 points on the National Institutes of Health Stroke Scale within 24 hours of treatment with intraarterial tenecteplase. A post hoc analysis was performed with a control cohort of MT patients (ALLY MT) not receiving intraarterial tenecteplase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>From April 2022 to July 2023, 218 MTs were performed at ProMedica Hospital (Toledo, OH), of which 20 patients were enrolled in ALLY. The mean age was 66.1\u00b113.8 years, with 35% women. Median baseline National Institutes of Health Stroke Scale scores and Alberta Stroke Program Early CT Scores were 13 (interquartile range, 9\u201318.8) and 10 (interquartile range, 9\u201310), respectively. IV thrombolysis was administered in 55%. Most patients presented with middle cerebral artery occlusion (90%). Post-MT modified Treatment in Cerebral Ischemia grade was 2b and 2c in 11 and 9 patients, respectively. Final modified Treatment in Cerebral Ischemia 2b, 2c, and 3 was achieved in 55% (11\/20), 35% (7\/20), and 10% (2\/20), respectively. Any intracranial hemorrhage was observed in 11 patients; however, only 1 patient had symptomatic intracranial hemorrhage. A favorable functional outcome (modified Rankin Scale score, 0\u20132) at 90 days was achieved in 50%. No difference in intracranial hemorrhage rates was observed between the ALLY and ALLY MT cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The use of adjunctive intraarterial tenecteplase up to 4.5 mg in patients with acute ischemic stroke with incomplete reperfusion post-MT is feasible and was not associated with increased rates of hemorrhage. Larger, randomized studies are needed to assess the safety and efficacy of intraarterial tenecteplase in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT05172934.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.124.048846","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T05:02:31Z","timestamp":1736312551000},"page":"355-361","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Safety of Adjunctive Intraarterial Tenecteplase Following Mechanical Thrombectomy: The ALLY Pilot Trial"],"prefix":"10.1161","volume":"56","clinical-trial-number":[{"clinical-trial-number":"nct05172934","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-1801","authenticated-orcid":true,"given":"Syed F.","family":"Zaidi","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., A.C.C., R.E.B., H.S.A., K.G., R.R., M.A.J.)."},{"name":"Department of Neurology, ProMedica Toledo Hospital, OH (S.F.Z., R.R., M.A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-6767","authenticated-orcid":true,"given":"Alicia C.","family":"Castonguay","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., A.C.C., R.E.B., H.S.A., K.G., R.R., M.A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4881-4698","authenticated-orcid":true,"given":"Osama O.","family":"Zaidat","sequence":"additional","affiliation":[{"name":"Mercy St. Vincent Hospital, Toledo, OH (O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9454-0678","authenticated-orcid":true,"given":"Ashutosh P.","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0602-8509","authenticated-orcid":true,"given":"Sunil A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1884-2196","authenticated-orcid":true,"given":"Diogo C.","family":"Haussen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (D.C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Radiology, Boston Medical Center, MA (T.N.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"Burgess","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., A.C.C., R.E.B., H.S.A., K.G., R.R., M.A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1301-1245","authenticated-orcid":true,"given":"Hisham S.","family":"Alhajala","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., A.C.C., R.E.B., H.S.A., K.G., R.R., M.A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Gharaibeh","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., A.C.C., R.E.B., H.S.A., K.G., R.R., M.A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5020-6483","authenticated-orcid":true,"given":"Hisham","family":"Salahuddin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Antelope Valley Medical Center, Los Angeles, CA 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Tenectplase versus alteplase for acute stroke within 4.5H of onset: the second alteplase-tenecteplase trial evaluation for stroke thrombolysis (ATTEST-2). Paper presented at: 15th World Stroke Congress 10\u201312 October 2023 Toronto Canada. Accessed October 12 2023","DOI":"10.2139\/ssrn.4831843"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(98)08020-9"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2023-021076"},{"key":"e_1_3_3_21_2","unstructured":"Intra-arterial tenecteplase after EVT in acute posterior circulation arterial occlusion-a multicenter randomized controlled trial. 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