Injecting Clot-Dissolving Drug After Removing Large Brain Artery Clot Improves Stroke Outcomes

By HospiMedica International staff writers
Posted on 10 Feb 2025

Image: Tissue plasminogen activator working to dissolving brain clot and improving blood flow to the part of the brain being deprived (Photo courtesy of American Heart Association)

Approximately 1 in 5 ischemic strokes, which are caused by a clot, occur due to a blockage in a large artery in the brain (large vessel occlusions). The standard treatment for this type of stroke is the swift removal of the clot to restore blood flow using minimally invasive endovascular therapy. This procedure involves inserting a narrow catheter (small tube) and/or a stent into an artery to retrieve the clot and restore circulation, helping to prevent further brain damage. Without treatment, more than 80% of individuals with strokes caused by large vessel occlusions face disability, and 20% may die, according to previous research. Even when clots are successfully removed, up to half of the patients may either die or remain disabled three months after the stroke. Now, preliminary late-breaking research presented at the American Stroke Association’s International Stroke Conference 2025 indicates that removing a clot from a large brain artery and then injecting the clot-dissolving drug tenecteplase into the artery may help stroke survivors achieve better function 90 days after their stroke compared to those who receive standard clot removal treatment alone.

The study, led by neurologists from Beijing Anzhen Hospital (Beijing, China) across 19 centers in China, investigated the safety and efficacy of directly injecting tenecteplase into a large brain artery (intra-arterial injection) near the site where the clot had been removed, to restore blood flow. All participants had large vessel occlusions and were treated between 4.5 and 24 hours after the last time they were observed to be in good health. According to the study design, 127 patients received tenecteplase and successfully underwent endovascular therapy, while 129 patients received only standard medical care after successful clot removal. Disability was evaluated using the modified Rankin Scale, which ranges from 0 (no disability) to 6 (death).

The analysis revealed that stroke survivors who received the tenecteplase injection along with standard care after clot removal were 44% more likely to have an excellent outcome (modified Rankin score 0-1) after 90 days than those who only received standard care (40.5% vs. 26.4%). The incidence of brain bleeds within two days after treatment was similar for both groups, with 5.6% of those receiving tenecteplase and 6.2% of those receiving standard medical care experiencing brain bleeds. Furthermore, the death rates within 90 days were comparable for both groups, with 21.4% in the tenecteplase group and 21.7% in the standard care group. The researchers continue to follow the participants to evaluate their outcomes at one year. They believe these findings could potentially influence future treatment guidelines for stroke survivors who have undergone successful clot removal.

“Intra-arterial tenecteplase after successful thrombectomy could improve the percentage of people with an excellent outcome. It could also improve the rate of large vessel occlusion stroke survivors who can return to society and live independently,” said Xiaochuan Huo, M.D., Ph.D., lead author of the study.