Evidence map›Paper›PMID 41136212›Full record

Trial reportJournal of neurointerventional surgery2026

Occlusion site and outcomes in intra-arterial tenecteplase after successful endovascular therapy: a secondary analysis of the ANGEL-TNK trial.

Shuo Li, Xin Tong, Huachen Zhang, Gang Luo, Ligang Song, Dapeng Sun, Wenhuo Chen, Xiaoxi Yao, Qi Zhou, Xuelei Zhang and 4 more

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of neurointerventional surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Shuo Li *Department of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Xin Tong *Department of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.ORCID http://orcid.org/0000-0002-4893-1299
Huachen Zhang *Department of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.ORCID http://orcid.org/0000-0002-4618-0380
Gang LuoInterventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China.ORCID http://orcid.org/0000-0003-1544-1434
Ligang SongInterventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China.
Dapeng SunInterventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China.ORCID http://orcid.org/0000-0001-6321-5381
Wenhuo ChenDepartment of Neurology, Fujian Medical University Union Hospital, Fuzhou, China.
Xiaoxi YaoDepartment of Neurology, Chenzhou No. 1 People's Hospital, Chenzhou, China.
Qi ZhouDepartment of Cardiovascular Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Xuelei ZhangDepartment of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Yiwen XuDepartment of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Thanh N NguyenDepartment of Neurology and Radiology, Boston Medical Center, Boston University, Boston, Massachusetts, USA.ORCID http://orcid.org/0000-0002-2810-1685
Zhongrong MiaoInterventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China.ORCID http://orcid.org/0000-0001-9642-9415
Xiaochuan HuoDepartment of Cerebral Vascular Disease, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China hxc810909@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndovascular thrombectomy achieves macroreperfusion in large vessel occlusion (LVO) stroke, but only one-quarter of patients had excellent functional outcome. Adjunct intra-arterial (IA) tenecteplase could further improve the treatment effect, yet its efficacy across internal carotid artery (ICA) versus middle cerebral artery (MCA) M1/M2 occlusion remains unclear.

objectiveTo evaluate whether IA tenecteplase improves 90-day functional outcomes in LVO patients stratified by occlusion site (ICA, MCA M1, MCA M2).

methodsPrespecified secondary analysis of the ANGEL-TNK trial (multicenter, randomized, open-label, blinded endpoint) in 19 Chinese stroke centers. Participants were enrolled who had anterior circulation LVO, 4.5-24 hours from symptom onset, and CT angiography (CTA)/magnetic resonance angiography (MRA)-proven ICA, M1, or M2 occlusion.

interventionRandomization (1:1) to IA tenecteplase (0.125 mg/kg) or standard medical management after expanded Thrombolysis in Cerebral Infarction (eTICI) 2b50-3 reperfusion.

main outcome measureThe primary outcome was the rate of 90-day modified Rankin Scale (mRS) 0-1.

resultsThere were 256 patients in the trial, including 71 (27.7%) ICA, 122 (47.6%) MCA M1, and 62 (24.2%) MCA M2. ICA occlusion patients treated with IA tenecteplase had higher rates of 90-day mRS 0-1 (39.4% vs 13.2%; relative risk (RR) 2.99; 95% CI 1.51 to 5.96; p=0.002) and mRS 0-3 (54.5% vs 42.1%; RR 1.30; p=0.048) versus controls, with a significant shift toward better mRS scores (median 3 (IQR 1-4) vs 4 (2-6); odds ratio (OR) 2.26; p<0.001). Post hoc analysis showed higher eTICI progression in ICA patients (51.5%) versus MCA M1 (37.9%) and M2 (25.7%). IA tenecteplase had a lower any intracranial hemorrhage within 48 hours in ICA patients (15.2% vs 39.5%; RR 0.38; p<0.001) compared with standard medical management. No significant benefits were observed in the MCA M1/M2 subgroups, and interaction effects were significant between ICA and MCA segments for functional outcomes and safety. CONCLUSIONS AND RELEVANCE: IA tenecteplase had a better functional outcome and lower hemorrhage risk in ICA occlusion compared with standard medical management but not in MCA M1/M2. Occlusion site is a critical determinant of response to IA tenecteplase. A pooled analysis of IA tenecteplase stratified by occlusion site strata is warranted.

Indexed as

Endovascular ProceduresFibrinolytic AgentsInfarction, Middle Cerebral ArteryTenecteplaseTissue Plasminogen ActivatorAgedCarotid Artery, InternalFemaleHumansInfusions, Intra-ArterialMaleMiddle AgedTreatment OutcomeFibrinolytic AgentsTenecteplaseTissue Plasminogen ActivatorAngioplastyArteryInterventionReperfusionStroke

Identifiers

PMID41136212
PMCPMC13638319

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.