Injecting Tenecteplase After Removing Brain Clots Improves Stroke Recovery

A groundbreaking study presented at the American Stroke Association’s International Stroke Conference 2025 in Los Angeles reveals that combining clot removal with the injection of tenecteplase can significantly enhance recovery for stroke survivors.

The Significance of Early Clot Removal

Stroke is a medical emergency, particularly when caused by a clot obstructing a large artery in the brain, known as a large vessel occlusion ischemic stroke. Standard treatment involves prompt endovascular therapy, where a catheter is used to remove the clot and restore blood flow.

However, even with successful clot removal, significant neurological damage can occur in the smaller blood vessels around the clot. This study investigates whether injecting the clot-dissolving drug, tenecteplase, directly into the brain artery can improve blood flow in these affected areas and, consequently, patient outcomes.

Endovascular treatment can help restore blood flow in a blocked large blood vessel. However, it might not improve blood flow in the smaller vessels and microcirculation in the area. This clinical trial tests whether delivering tenecteplase directly into the affected artery after endovascular treatment can break up blood clots in the small vessels and improve blood flow, reducing the amount of brain tissue that lacks blood supply.

Xiaochuan Huo, M.D., Ph.D., lead author of the study and director of the neurological disease center at Beijing Anzhen Hospital, China

Methodology of the Study

The ANGEL-TNK trial was conducted at 19 centers in China and involved 255 participants aged between 40 and 85 (mean age of 70; 44.7% female). All participants had experienced an ischemic stroke obstructing a large artery in the brain that had been successfully treated within 4.5 to 24 hours of their last known normal state.

Participants were randomly divided into two groups. One group received standard medical care after clot removal, while the other received standard care plus an intra-arterial injection of tenecteplase near the clot location. The primary outcome measure was the percentage of participants with no to mild disabilities at 90 days, assessed using the modified Rankin Scale.

Results and Implications

The study found that patients who received tenecteplase after clot removal had a 44% higher chance of achieving excellent outcomes (modified Rankin Scale score of 0-1) after 90 days compared to those who received standard care (40.5% vs. 26.4%).

Importantly, the rates of brain bleeds in the two days following treatment and the death rates within 90 days were similar for both groups. These findings suggest that adding tenecteplase to the treatment regimen does not introduce additional safety risks.

Lead author Xiaochuan Huo emphasized the potential of this treatment approach in improving stroke outcomes and enabling more survivors to return to independent living.

Future Directions

While these results are promising, Huo and his team caution that further research is needed. They plan to conduct individual meta-analyses of data from this and other trials to provide a more robust evidence base and potentially influence treatment guidelines.

Notably, the study did not include patients who had received intravenous clot-busting drugs or other anti-coagulants during their endovascular procedures. Therefore, the benefits observed may not apply to all stroke patients.

Conclusion

This clinical trial represents a significant step forward in the treatment of large vessel occlusion ischemic strokes. By combining endovascular clot removal with intra-arterial tenecteplase, doctors may be able to improve blood flow and reduce neurological damage, ultimately enhancing the recovery of stroke patients.

As more studies are conducted and the evidence base grows, this innovative treatment could become a new standard of care, improving outcomes for countless stroke survivors.

If you or someone you know has experienced a stroke, discussing the latest treatment options with a healthcare provider is essential. Stay informed and advocate for the best possible care.

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