{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:15:40Z","timestamp":1788156940248,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess whether intravenous tenecteplase is associated with improved clinical outcomes compared with standard medical treatment (SMT) in patients with minor acute ischemic stroke (AIS) caused by medium-vessel occlusion (MeVO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter, retrospective observational study of consecutive patients with minor AIS, defined as a National Institutes of Health Stroke Scale score &amp;lt;6, and imaging-confirmed anterior-circulation MeVO. Patients were classified into the tenecteplase group or the SMT group (without intravenous thrombolysis) based on their initial treatment strategy. The primary outcome was excellent functional outcome at 90\u202fdays, defined as a modified Rankin Scale (mRS) score of 0\u20131. Secondary outcomes included functional independence at 90\u202fdays (mRS 0\u20132). Inverse probability of treatment weighting (IPTW)-adjusted analyses were performed to balance measured baseline characteristics between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 216 patients were included, of whom 64 received tenecteplase and 152 received SMT. After IPTW adjustment, tenecteplase was associated with a higher likelihood of excellent functional outcome at 90\u202fdays compared with SMT (70.3% vs. 53.3%; adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.11\u20133.87). Tenecteplase was also associated with a higher rate of functional independence at 90\u202fdays (mRS 0\u20132: 81.3% vs. 64.5%; aOR, 2.39; 95% CI, 1.18\u20134.87). No statistically significant differences were observed in hemorrhagic transformation (5.2% vs. 7.0%) or symptomatic intracranial hemorrhage (3.4% vs. 4.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with minor AIS caused by anterior-circulation MeVO, tenecteplase was associated with better functional outcomes, without an apparent increase in hemorrhagic complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1931392","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:40:13Z","timestamp":1788154813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tenecteplase versus standard medical treatment for minor stroke due to anterior-circulation medium-vessel occlusion: a multicenter observational study"],"prefix":"10.3389","volume":"20","author":[{"given":"He","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Neurology, Dongtai People's Hospital","place":["Yancheng, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dongtai People's Hospital","place":["Yancheng, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University (Taizhou Clinical Medical School of Nanjing Medical University)","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanguo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dongtai People's Hospital","place":["Yancheng, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1056\/NEJMoa1716405","article-title":"Tenecteplase versus alteplase before thrombectomy for ischemic stroke","volume":"378","author":"Campbell","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.1001\/jama.2023.7827","article-title":"Dual antiplatelet therapy vs Alteplase for patients with minor nondisabling acute ischemic stroke: the ARAMIS randomized clinical trial","volume":"329","author":"Chen","year":"2023","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1177\/17474930231205213","article-title":"Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: a randomized controlled trial","volume":"19","author":"Claren\u00e7on","year":"2024","journal-title":"Int. J. Stroke"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2597","DOI":"10.1016\/S0140-6736(24)00921-8","article-title":"Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial","volume":"403","author":"Coutts","year":"2024","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1056\/NEJMoa2411668","article-title":"Endovascular treatment of stroke due to medium-vessel occlusion","volume":"392","author":"Goyal","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2513","DOI":"10.1161\/STROKEAHA.111.000048","article-title":"Importance of cerebral artery recanalization in patients with stroke with and without neurological improvement after intravenous thrombolysis","volume":"44","author":"Kharitonova","year":"2013","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1001\/jama.2018.8496","article-title":"Effect of Alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial","volume":"320","author":"Khatri","year":"2018","journal-title":"JAMA"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1177\/17474930251381946","article-title":"Factors associated with early neurological deterioration in minor distal medium vessel acute ischemic stroke: a multinational multicenter study","volume":"21","author":"Lakhani","year":"2026","journal-title":"Int. J. Stroke"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1136\/neurintsurg-2020-016583","article-title":"More expansive horizons: a review of endovascular therapy for patients with low NIHSS scores","volume":"13","author":"McCarthy","year":"2021","journal-title":"J. Neurointerv. Surg."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.3174\/ajnr.A7253","article-title":"Patient-relevant deficits dictate endovascular Thrombectomy decision-making in patients with low NIHSS scores with medium-vessel occlusion stroke","volume":"42","author":"McDonough","year":"2021","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"190","DOI":"10.5853\/jos.2023.02649","article-title":"Distal medium vessel occlusion strokes: understanding the present and paving the way for a better future","volume":"26","author":"Nogueira","year":"2024","journal-title":"J. Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3232","DOI":"10.1161\/STROKEAHA.120.030227","article-title":"Clinical course of acute ischemic stroke due to medium vessel occlusion with and without intravenous Alteplase treatment","volume":"51","author":"Ospel","year":"2020","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 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","year":"2026","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1056\/NEJMoa2408954","article-title":"Endovascular treatment for stroke due to occlusion of medium or distal vessels","volume":"392","author":"Psychogios","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1136\/jnis-2024-022124","article-title":"Nomogram for predicting early neurological deterioration in patients with mild large and medium vessel occlusion stroke intended for medical management: a multicenter retrospective study","volume":"17","author":"Qiu","year":"2025","journal-title":"J. Neurointerv. Surg."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e001110","DOI":"10.1161\/SVIN.123.001110","article-title":"A systematic review of the efficacy and safety of Tenecteplase versus Alteplase in acute ischemic stroke: a time to pass the torch","volume":"4","author":"Rodriguez","year":"2024","journal-title":"Stroke Vasc. Interv Neurol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"von Kummer","year":"2015","journal-title":"Stroke"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1931392\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:40:14Z","timestamp":1788154814000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1931392\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":17,"alternative-id":["10.3389\/fnins.2026.1931392"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1931392","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"1931392"}}