Evidence map›Paper›PMID 41491042›Full record

ArticleJournal of neurology2026

Early reperfusion with tenecteplase vs alteplase before stroke thrombectomy: impact of clot burden, thrombus characteristics, and collateral status.

Tyler M Bielinski, Kelsey E Kline, Grant N Badger, Veronica N Bohl, Sina Hemmer, Wysteria Stedman, Jiang Li, Clemens M Schirmer, Oded Goren, Philipp Hendrix

Abstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Journal of neurology, 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

10 authors.

Tyler M BielinskiGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Kelsey E KlineGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Grant N BadgerGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Veronica N BohlGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Sina HemmerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Wysteria StedmanNeuroscience Institute, Geisinger, Danville, PA, USA.
Jiang LiDepartment of Molecular and Functional Genomics, Weis Center for Research, Geisinger, Danville, PA, USA.
Clemens M SchirmerDepartment of Neurosurgery, Geisinger, Wilkes-Barre, PA, USA.
Oded GorenDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Philipp HendrixDepartment of Neurosurgery, Geisinger, Danville, PA, USA. hendrix.philipp@gmail.com.ORCID http://orcid.org/0000-0003-0017-5049

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly reperfusion (ER) following intravenous thrombolysis improves outcomes in large vessel occlusion stroke (LVOS). Tenecteplase (TNK) has been associated with higher ER rates than alteplase (TPA), but findings across studies remain inconsistent, possibly due to limited adjustment for thrombus burden, characteristics, and collateral status. We compared TNK and TPA in a real-world cohort incorporating imaging-based assessment of thrombus and collateral status.

methodsWe retrospectively analyzed consecutive anterior circulation LVOS patients who received intravenous thrombolysis prior to thrombectomy at two U.S. comprehensive stroke centers (2020-2024). ER was defined as eTICI ≥ 2b50 on initial angiography or confirmed recanalization in clinically improving patients who did not undergo thrombectomy. Imaging review included clot burden score, thrombus length, thrombus permeability, and collateral status (Tan scale). Multivariable logistic regression identified predictors of ER. Ordinal logistic regression assessed the association between ER and 90-day modified Rankin Scale (mRS) shift.

resultsAmong 299 patients (TNK 201, TPA 98), ER occurred in 60 (20.1%). ER was more frequent with TNK than TPA (24.4% vs 11.2%, p = 0.008). TNK was independently associated with ER (adjusted OR 2.54, 95% CI 1.19-5.42). Additional predictors included thrombus permeability (aOR 3.30, 95% CI 1.73-6.30) and lower NIHSS (aOR 0.94 per point, 95% CI 0.89-0.98), while tandem occlusion reduced ER likelihood (aOR 0.18, 95% CI 0.05-0.62). ER independently predicted better 90-day mRS (aOR 2.09, 95% CI 1.21-3.60).

conclusionsTenecteplase achieved superior early reperfusion compared to alteplase after accounting for clot burden, thrombus features, and collateral status, reinforcing its clinical advantage in LVOS thrombolysis.

Indexed as

Fibrinolytic AgentsIschemic StrokeReperfusionTenecteplaseThrombectomyThrombosisTissue Plasminogen ActivatorAgedAged, 80 and overCollateral CirculationFemaleHumansMaleMiddle AgedRetrospective StudiesThrombolytic TherapyFibrinolytic AgentsTenecteplaseTissue Plasminogen ActivatorAlteplaseEarly reperfusionLarge vessel occlusion strokeTenecteplase

Identifiers

PMID41491042

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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.