Tenecteplase versus standard medical treatment for minor stroke due to anterior-circulation medium-vessel occlusion: a multicenter observational study.

PURPOSE: To assess whether intravenous tenecteplase is associated with improved clinical outcomes compared with standard medical treatment (SMT) in patients with minor acute ischemic stroke (AIS) caused by medium-vessel occlusion (MeVO). METHODS: We conducted a multicenter, retrospective observational study of consecutive patients with minor AIS, defined as a National Institutes of Health Stroke Scale score <6, and imaging-confirmed anterior-circulation MeVO. Patients were classified into the tenecteplase group or the SMT group (without intravenous thrombolysis) based on their initial treatment strategy. The primary outcome was excellent functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0-1. Secondary outcomes included functional independence at 90 days (mRS 0-2). Inverse probability of treatment weighting (IPTW)-adjusted analyses were performed to balance measured baseline characteristics between groups. RESULTS: A total of 216 patients were included, of whom 64 received tenecteplase and 152 received SMT. After IPTW adjustment, tenecteplase was associated with a higher likelihood of excellent functional outcome at 90 days compared with SMT (70.3% vs. 53.3%; adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.11-3.87). Tenecteplase was also associated with a higher rate of functional independence at 90 days (mRS 0-2: 81.3% vs. 64.5%; aOR, 2.39; 95% CI, 1.18-4.87). No statistically significant differences were observed in hemorrhagic transformation (5.2% vs. 7.0%) or symptomatic intracranial hemorrhage (3.4% vs. 4.3%). CONCLUSION: Among patients with minor AIS caused by anterior-circulation MeVO, tenecteplase was associated with better functional outcomes, without an apparent increase in hemorrhagic complications.