Evidence map›Paper›PMID 41288159›Full record

ArticleAnnals of neurology2026

Tenecteplase Versus Alteplase for First-Pass Reperfusion in Basilar Artery Occlusion Stroke Thrombectomy.

Dylan N Wolman, Rahul R Karamchandani, Sina Hemmer, Tyler M Bielinski, Nitin Goyal, Jeremy B Rhoten, Mahesh V Jayaraman, Christian T Sidebottom, Bradley A Gross, Alhamza R Al-Bayati and 29 more

Abstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–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

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. 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

39 authors.

Dylan N WolmanDepartment of Radiology, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI, USA.ORCID 0000-0002-5012-1690
Rahul R KaramchandaniDepartment of Neurology, Wake Forest University School of Medicine, Neurosciences Institute, Advocate Health, Charlotte, NC, USA.
Sina HemmerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Tyler M BielinskiGeisinger College of Health Sciences, Scranton, PA, USA.
Nitin GoyalDepartment of Neurology, Semmes Murphey Clinic, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Jeremy B RhotenDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Mahesh V JayaramanDepartment of Radiology, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI, USA.
Christian T SidebottomDepartment of Neurology, Semmes Murphey Clinic, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Bradley A GrossDepartment of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Alhamza R Al-BayatiDepartment of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Mohamed F DoheimDepartment of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.ORCID 0000-0001-8279-5078
Matthew K TobinDepartment of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.ORCID 0000-0001-5717-5133
Anoop ChinthalaDepartment of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Avi GajjarDepartment of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Justin MascitelliDepartment of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Matthew R WebbDepartment of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Kyle W ScottDepartment of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Visish SrinivasanDepartment of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Daniel TonettiDepartment of Neurological Surgery, Cooper University Health Care, Camden, NJ, USA.
Manisha KoneruDepartment of Neurological Surgery, Cooper University Health Care, Camden, NJ, USA.ORCID 0000-0001-5012-6793
David J AltschulDepartment of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.ORCID 0000-0002-5130-1378
Dhrumhil VaishnavDepartment of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Sumeet MultaniMain Line Health-Jefferson Neurosurgery, Paoli, PA, USA.
Thana TheofanisMain Line Health-Jefferson Neurosurgery, Paoli, PA, USA.
William J AresDepartment of Neurosurgery, Northshore University HealthSystem, Evanston, IL, USA.
Je Yeong SoneDepartment of Neurosurgery, Northshore University HealthSystem, Evanston, IL, USA.
Ramin ZandDepartment of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.ORCID 0000-0002-9477-0094
Sasan BahramiDepartment of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
Jiang LiDepartment of Molecular and Functional Genomics, Weis Center for Research, Danville, PA, USA.
Gary DefilippCharlotte Radiology, Advocate Health, Charlotte, NC, USA.
Dale StrongInformation and Analytics Services, Advocate Health, Charlotte, NC, USA.
Radmehr TorabiDepartment of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI, USA.
Krisztina MoldovanDepartment of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI, USA.
Clemens M SchirmerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Alexandra R PaulDepartment of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Bradley N BohnstedtDepartment of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Raul G NogueiraDepartment of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Philipp HendrixDepartment of Neurosurgery, Geisinger, Danville, PA, USA.ORCID 0000-0003-0017-5049

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe first-pass effect (FPE), defined as excellent reperfusion after a single attempt, is associated with improved outcomes in large vessel occlusion stroke. We evaluated whether intravenous tenecteplase (TNK) compared with alteplase (TPA) increases the likelihood of FPE in basilar artery occlusion (BAO).

methodsWe analyzed 163 consecutive BAO patients treated with intravenous TNK or TPA within 4.5 h of last known well across 14 U.S. stroke systems (January 2020-August 2024). Patients with early reperfusion (n = 27) or aborted procedures (n = 3) were excluded. Multivariable ordinal and logistic regression identified predictors of FPE (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c-3) and modified FPE (mFPE, eTICI 2b-3), and FPE/mFPE association with 90-day outcomes (modified Rankin Scale [mRS] 0-3).

resultsFPE occurred in 55 of 133 patients (41.4%) and was more frequent with TNK than TPA (51.7% vs 32.9%, p = 0.029). TNK was independently associated with higher odds of FPE (adjusted odds ratio [aOR] 2.37, 95% confidence interval [CI] 1.13-4.98, p = 0.023) and mFPE (aOR 2.74, 95% CI 1.20-6.25, p = 0.017). Both FPE and mFPE were independently associated with ambulatory outcomes at 90-days (FPE: aOR 2.94, 95% CI 1.18-7.33, p = 0.021; mFPE: aOR 5.11, 95% CI 1.81-14.43, p = 0.002). TNK compared with TPA did not show an independent association with functional outcome.

interpretationIn this multicenter BAO cohort, TNK increased the odds of achieving FPE compared with TPA. As FPE strongly predicted functional recovery, these findings suggest TNK may confer a reperfusion advantage with potential clinical benefit, although a direct outcome effect was not demonstrated. ANN NEUROL 2026;99:692-704.

Indexed as

Fibrinolytic AgentsIschemic StrokeReperfusionTenecteplaseThrombectomyTissue Plasminogen ActivatorVertebrobasilar InsufficiencyAgedAged, 80 and overFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeFibrinolytic AgentsTenecteplaseTissue Plasminogen Activator

Identifiers

PMID41288159
PMCPMC12954158

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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.