Intravenous Thrombolysis With Tenecteplase in Patients With Large Vessel Occlusions

Systematic Review and Meta-Analysis

Aristeidis H. Katsanos, MD; Apostolos Safouris, MD; Amrou Sarraj, MD; Georgios Magoufis, MD; Ronen R. Leker, MD; Pooja Khatri, MD; Charlotte Cordonnier, MD; Didier Leys, MD; Ashkan Shoamanesh, MD; Niaz Ahmed, MD; Andrei V. Alexandrov, MD; Georgios Tsivgoulis, MD


Stroke. 2021;52(1):308-312. 

In This Article


The authors declare that all supporting data are available within the article and its Data Supplement. The present systematic review and meta-analysis is reported according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses statement.

We searched for published RCTs reporting outcomes of AIS patients with confirmed LVO randomized to intravenous thrombolytic treatment with either tenecteplase or alteplase. Further information on the literature search and data analysis is available in the Data Supplement.

Risk of bias for each included study was assessed with the Cochrane Collaboration risk-of-bias tool, while the quality of summary evidence for each outcome of interest was evaluated using the methodology developed by the Grading of Recommendations Assessment, Development and Evaluation Working Group.[5]

The primary outcome of interest was the odds of favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0 to 2 at 3 months. Secondary outcomes of interest included the odds of (1) excellent outcome defined as 3-month mRS scores of 0 or 1, (2) 3-month all-cause mortality, (3) 3-month functional improvement (assessed with ordinal logistic regression analysis on the per 1-point decline in the ordinal mRS score [range, 0–6] at 3 months), (4) any intracranial hemorrhage (ICH), (5) symptomatic ICH (according to the definition used in each study), (6) successful recanalization (according to the definition used in each study), and (7) early neurological improvement (according to the definition used in each study).