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WSC 2022 | Thrombectomy alone versus with prior tenecteplase: what do we know?

Urs Fischer, MD, Basel University Hospital, Basel, Switzerland, and Yvo B. Roos, MD, PhD, Amsterdam University Medical Center, Amsterdam, The Netherlands, discuss how the growing use of intravenous tenecteplase could impact the ongoing debate surrounding the value of bridging thrombolysis prior to endovascular thrombectomy for the treatment of acute ischemic stroke. Numerous large, randomized, placebo-controlled trials have assessed the use of direct mechanical thrombectomy (MT) versus MT with prior intravenous alteplase, finding no difference in outcomes between the two approaches. Only one of these trials included patients who received tenecteplase in the bridging arm, so we currently do not know if these findings extend to tenecteplase use. The DIRECT-TNK trial (NCT05199194) is an ongoing study aiming to shed light on this question. Over 500 patients with acute ischemic stroke due to large vessel occlusion will be randomized to receive MT alone or preceded by thrombolysis with tenecteplase. This interview took place at the World Stroke Congress 2022 in Singapore.

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Prof. Fischer reports the following disclosures:
-research grants from Medtronic (BEYOND SWIFT, SWIFT DIRECT) and from Stryker, Rapid medical, Penumbra and Phenox (DISTAL).
-consultancies for Medtronic, Stryker, and CSL Behring (fees paid to institution).
-participation in an advisory board for Alexion/Portola and Boehringer Ingelheim (fees paid to institution).