Today, at the 2026 European Stroke Organisation Conference (ESOC; 6–8 May, Maastricht, Netherlands), findings from the TECNO trial were presented for the first time, with results indicating that intra-arterial tenecteplase did not significantly improve early or late reperfusion rates compared to best medical treatment in stroke patients with incomplete reperfusion following mechanical thrombectomy. However, the administration of tenecteplase was found to be safe regarding intracranial bleeding.
According to the TECNO researchers, these results highlight the need for further refinement of patient selection and treatment protocols in this setting to tackle the “common and clinical important challenge” of incomplete reperfusion after a thrombectomy.
TECNO was a multicentre, randomised, open-label, blinded-endpoint trial designed to test whether a 3mg dose of direct intra-arterial tenecteplase in addition to best medical treatment improves reperfusion in patients with incomplete post-thrombectomy reperfusion. The trial was coordinated by researchers from Switzerland and conducted across multiple high-volume stroke centres in Europe.
Its primary efficacy endpoints were early and late reperfusion, as defined by reperfusion improvement on angiography imaging 25 minutes after randomisation, and complete reperfusion on 24-hour magnetic resonance (MR)/computed tomography (CT) perfusion imaging, respectively.
In the primary analysis, improved early reperfusion was observed in 39% of patients randomised to tenecteplase compared with 36% in the control group, corresponding to an adjusted risk difference of 3.4% (95% confidence interval [CI], -15–21.7%) that was not statistically significant. Additionally, late reperfusion at 24 hours was observed in 51% versus 40% of patients in the tenecteplase and control groups, respectively, resulting in an adjusted risk difference of 15.4% (95% CI, -3.3–32.9%) that was also non-significant.
Regarding safety, symptomatic intracranial haemorrhage (ICH) occurred in 5.2% of patients in the tenecteplase group compared with 8.6% in the control group, confirming an acceptable safety profile with respect to intracranial bleeding.
At 90 days, functional independence—as per a modified Rankin scale (mRS) score of 0–2—was achieved by 27% of patients in the tenecteplase group compared with 38% in the control group (adjusted conditional odds ratio [acOR], 0.6; 95% CI, 0.34–1.06). On this detail, however, the investigators emphasise that the trial was designed and powered to evaluate reperfusion as its primary endpoint, and that definitive conclusions regarding clinical outcomes should not be drawn solely from these data.
“Taken alone, these findings do not support the routine administration of intra-arterial tenecteplase as a pharmacological adjunct in cases of incomplete reperfusion,” said TECNO principal investigator Johannes Kaesmacher (Bern University Hospital, Bern, Switzerland), who presented these late-breaking data at ESOC 2026.
Ultimately—according to the researchers—the TECNO trial does not demonstrate a significant benefit with intra-arterial tenecteplase in terms of reperfusion or clinical outcomes following incomplete thrombectomy, but does confirm its safety regarding intracranial bleeding. The investigators also feel that these results highlight the need for further trials with more refined patient selection and optimised treatment protocols to address the ongoing challenge of incomplete reperfusion in acute stroke care.
