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WSC 2026 | Which patients with ischemic stroke should receive intra-arterial thrombolysis after thrombectomy?

Urs Fischer, MD, Inselspital, Bern University Hospital, Bern, Switzerland, discusses which patients should receive intra-arterial thrombolysis after thrombectomy, highlighting that trials to date have had different inclusion criteria. Prof. Fischer explains that the TECNO trial (NCT05499832) showed no benefit of intra-arterial tenecteplase in patients with incomplete reperfusion, so it should not be used routinely in this setting unless new evidence emerges. However, he adds that intra-arterial thrombolysis can be considered in patients with complete or near-complete reperfusion, although more data are urgently needed. This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.

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Transcript

I think it’s very important to notice that the different trials, which have been published or presented so far, had different inclusion-exclusion criteria. The TECNO trial, which you mentioned, was specifically targeting people with incomplete reperfusion, whereas the other trials were focusing on people with nearly complete or complete reperfusion. And we strongly believe that this is a different setting...

I think it’s very important to notice that the different trials, which have been published or presented so far, had different inclusion-exclusion criteria. The TECNO trial, which you mentioned, was specifically targeting people with incomplete reperfusion, whereas the other trials were focusing on people with nearly complete or complete reperfusion. And we strongly believe that this is a different setting. So TECNO was not able to show a benefit in people with incomplete reperfusion, and therefore this should, intra-arterial thrombolysis should not be applied in routine clinical practice unless there is new evidence. Whereas it can be considered in people with complete or almost complete reperfusion, nevertheless there are still open questions and that was the reason why we wrote in our editorial that more data are urgently needed for this particular setting as well.

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