{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:31:50Z","timestamp":1789129910681,"version":"build-2803163510"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neuroradiol J"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The role of intravenous tenecteplase (TNK) in patients with acute ischemic stroke presenting 4.5\u201324\u00a0hours after last known well remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and frequentist and Bayesian meta-analysis of Randomized Controlled Trials (RCTs) comparing TNK-containing with trial-specific non-TNK strategies in imaging-selected patients with anterior-circulation large- or medium-vessel occlusion treated 4.5\u201324\u00a0hours after last known well. Trials represented heterogeneous reperfusion paradigms. The primary efficacy outcome was mRS 0-1 at 90\u00a0days; other functional, neurological, reperfusion, and recanalization outcomes were secondary or exploratory, and hemorrhagic events were assessed separately as safety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four multicenter RCTs comprising 1,589 patients were included. Frequentist analysis showed no significant difference in the primary outcome, mRS 0-1 at 90\u00a0days (OR 1.29, 95% CI 0.99\u20131.67), or in secondary functional outcomes and mortality. Symptomatic intracranial hemorrhage (OR 1.79, 95% CI 0.88\u20133.60) and parenchymal hematoma (OR 2.02, 95% CI 0.60\u20136.74) were numerically more frequent with TNK. No significant interaction was observed according to reperfusion strategy (P-interaction &gt;0.36), although subgroup analyses were exploratory and underpowered. Bayesian analyses yielded estimates favoring TNK for excellent functional outcome (OR 1.29, 95% CrI 1.10\u20131.51) but also suggested increased risks of symptomatic intracranial hemorrhage (OR 1.79, 95% CrI 1.15\u20132.76) and parenchymal hematoma (OR 2.02, 95% CrI 1.14\u20133.47); these findings should be interpreted cautiously given their dependence on Bayesian model assumptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Across heterogeneous reperfusion paradigms, TNK-containing strategies showed no consistent functional benefit, while hemorrhagic outcomes raised a potential safety signal. Pooled estimates should not be interpreted as a uniform treatment effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19714009261487616","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:09:37Z","timestamp":1788876577000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tenecteplase for anterior-circulation vessel occlusion at 4.5-24 hours across reperfusion paradigms: A meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0619-4796","authenticated-orcid":false,"given":"Jo\u00e3o Vitor","family":"Andrade Fernandes","sequence":"first","affiliation":[{"name":"Federal University of Para\u00edba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Caruso Novaes","family":"Tudella","sequence":"additional","affiliation":[{"name":"Federal University of Santa Maria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4898-3601","authenticated-orcid":false,"given":"Leonardo","family":"Reischoffer do Nascimento","sequence":"additional","affiliation":[{"name":"Amazonas State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Victor de Oliveira","family":"Ramos","sequence":"additional","affiliation":[{"name":"Federal University of Para\u00edba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Boston Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":false,"given":"Adam A.","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"University of Oxford"},{"name":"Harvard Medical School"},{"name":"Toronto Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930241308142"},{"issue":"23","key":"e_1_3_6_3_2","doi-asserted-by":"crossref","first-page":"e036142","DOI":"10.1161\/JAHA.124.036142","article-title":"Projections of the stroke burden at the global, regional, and national levels up to 2050 based on the global burden of disease study 2021","volume":"13","author":"Cheng Y","year":"2024","unstructured":"Cheng Y, Lin Y, Shi H, et al. Projections of the stroke burden at the global, regional, and national levels up to 2050 based on the global burden of disease study 2021. J Am Heart Assoc 2024; 13(23): e036142. https:\/\/doi.org\/10.1161\/JAHA.124.036142","journal-title":"J Am Heart Assoc"},{"key":"e_1_3_6_4_2","article-title":"Guideline for the early management of patients with acute ischemic stroke: a guideline from the American heart association\/American stroke association","volume":"57","author":"Prabhakaran S","year":"2026","unstructured":"Prabhakaran S, Gonzalez NR, Zachrison KS, et al. Guideline for the early management of patients with acute ischemic stroke: a guideline from the American heart association\/American stroke association. 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