The BRIDGE-TNK randomised clinical trial has shown better outcomes in stroke patients receiving thrombectomy plus ‘bridging treatment’ with the intravenous thrombolytic drug tenecteplase as compared to thrombectomy alone. The study—featured earlier today at the 11th European Stroke Organisation Conference (ESOC; 21–23 May, Helsinki, Finland) and now also published in the New England Journal of Medicine—included patients with acute ischaemic strokes caused by large vessel occlusion (LVO) presenting within 4.5 hours of symptom onset.
BRIDGE-TNK included 550 patients from 39 hospitals in China, with 278 receiving bridging treatment with tenecteplase and 278 receiving thrombectomy alone. The primary endpoint was a 90-day modified Rankin scale (mRS) score of 0–2, a metric generally considered equivalent to functional independence.
The BRIDGE-TNK investigators’ hypothesis was that bridging treatment with intravenous thrombolysis would be superior to thrombectomy alone—and, with the data presented today, theirs becomes the first randomised trial to demonstrate superiority with bridging treatment involving tenecteplase specifically compared to thrombectomy alone.
The proportion of patients with a good functional outcome of mRS 0–2 was 52.9% in the bridging group versus 44.1% in patients receiving only thrombectomy, as per a late-breaking presentation at ESOC 2025 from leading BRIDGE-TNK investigators Guangxiong Yuan (Xiangtan Central Hospital, Xiangtan, China) and Thanh N Nguyen (Boston University School of Medicine, Boston, USA). The researchers reported that the adjusted risk ratio for a good functional outcome with bridging treatment was 1.18 (95% confidence interval [CI], 1.01–1.39; p=0.04), while mortality rates and the occurrence of symptomatic bleeding complications did not differ significantly between the two study groups.
Following these positive primary-endpoint findings, the presenters relayed that data on the trial’s secondary endpoints relating to functional outcomes were “less robust”: rates of 90-day mRS 0–1 were 34.9% with tenecteplase plus thrombectomy versus 27.9% with thrombectomy alone. In addition, first-pass reperfusion rates were not statistically significantly different between the two groups, at 41% and 39.5%, respectively. However, the bridging thrombolysis group did see a higher proportion of successful reperfusion on initial angiogram prior to thrombectomy, and intravenous tenecteplase was also reported to have enabled a nine-minute reduction in the time from puncture to reperfusion—independent of rescue therapies like angioplasty and/or stenting.
As many as six previous randomised controlled trials have investigated whether intravenous thrombolysis can provide additional clinical benefits over thrombectomy alone in LVO stroke patients arriving directly at a thrombectomy-capable centre. Results from these trials have more recently been merged to create IRIS—an individual patient data meta-analysis in which neither non-inferiority nor superiority of bridging treatment could be established.
However, the thrombolytic agent under investigation in the majority of prior trials was alteplase, a more well-established and widely used drug than tenecteplase. It has been posited by researchers that, with its longer half-life and higher affinity for fibrin in blood clots, tenecteplase may possess the better clot-dissolving properties of the two drug candidates.
Zhongming Qiu (Xinqiao Hospital of Army Medical University, Chongqing, China), one of the lead authors for BRIDGE-TNK, commented: “This is the first clinical trial to directly validate the therapeutic value of tenecteplase combined with thrombectomy, indicating that early thrombolysis could potentially accelerate recanalisation, streamline procedural workflows, and thereby improve patient outcomes.”
Yuan and Nguyen concluded their presentation by drawing attention to the upcoming BRIDGE-TNK EXTEND study—a randomised, double-blinded trial evaluating tenecteplase plus thrombectomy versus placebo plus thrombectomy in LVO ischaemic stroke patients presenting 4.5–24 hours from time last known well. Enrolment in the trial will be initiated in October this year, with approximately 820 patients set to be randomised between the two study arms.
