SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1661357
Tenecteplase versus alteplase in bridging therapy in patients with large vessel occlusion stroke : a meta‑analysis
Provisionally accepted
Xiaohan ZhangMin TaoTian WangRongxin HeLingwan YanXiaozuo LinPingkai WangYinan ZengJipeng YuHongxia Liu*
Man Luo*- First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Background Currently, for patients with large-vessel occlusion (LVO) strokes, the standard treatment approach involves using alteplase (ALT) as a bridge to endovascular mechanical thrombectomy (MT). Tenecteplase (TNK) is a novel fibrinolytic agent. Our research is focused on evaluating and comparing the efficacy and safety of TNK and ALT in patients with acute ischemic stroke (AIS) and large-vessel occlusion before they undergo MT. Methods The study's research plan was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42025643339. The entire process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, guaranteeing high - quality and standardized reporting and analysis. Results In total, 7 studies involving 4580 patients were incorporated. Patients treated with TNK exhibited comparable rates of functional independence at 90 days (odds ratio 1.23, 95% confidence interval 0.90-1.68, p =0.2), post-MT recanalization (1.18, 0.93-1.51, p =0.18), symptomatic intracerebral hemorrhage (sICH) (1.01, 0.62-1.65, p =0.98) and mortality within 90 days (0.77, 0.51-1.18, p =0.24) to those treated with alteplase. However, compared to alteplase-treated patients, those treated with TNK had higher rates of early recanalization (1.28, 1.06-1.53, p =0.009), and a lower incidence of intracranial hemorrhage (ICH) (1.83, 1.26-2.66, p =0.002). Conclusion Regarding of functional independence at 90 days, post-MT recanalization, sICH and 90-day mortality in AIS patients undergoing MT, there were essentially no difference between TNK and ALT. However, TNK might be more effective than ALT in achieving early recanalization, and it may also reduce the risks of ICH.
Keywords: Acute ischemic stroke, tenecteplase, alteplase, intravenous thrombolysis, Mechanical thrombectomy
Received: 07 Jul 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Zhang, Tao, Wang, He, Yan, Lin, Wang, Zeng, Yu, Liu and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongxia Liu, yfy003417@sr.gxmu.edu.cn
Man Luo, luoman@gxmu.edu.cn
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