Intra-arterial tenecteplase has demonstrated potential as a safe and feasible adjunct to mechanical thrombectomy in patients with acute ischaemic stroke caused by a distal large vessel occlusion (LVO) who achieve “successful but incomplete” reperfusion, as per findings from the ALLY pilot study.
Presenting these results at the Society of Vascular and Interventional Neurology (SVIN) annual meeting (16–18 November 2023, Miami, USA), Fazal Zaidi (University of Toledo/Promedica Toledo Hospital, Toledo, USA) revealed that tenecteplase was not associated with any major complications, and that there was evidence of the thrombolytic drug being linked to improved distal perfusion on angiographic images.
Zaidi also noted that ALLY is the first US study to have investigated intra-arterial tenecteplase in patients with residual, distal LVOs who achieved final reperfusion scores of 2b or 2c on the thrombolysis in cerebral infarction (TICI) scale post-thrombectomy.
ALLY—a prospective, single‐centre, single‐arm pilot study—enrolled adult patients aged 18–85 years with anterior-circulation LVO occlusions in their internal carotid artery (ICA)/middle cerebral artery (MCA) and a premorbid modified Rankin scale (mRS) score of ≤3. According to Zaidi, all enrolled patients received at least one 1.5mg bolus dose of tenecteplase, with additional treatments—up to a maximum of 4.5mg—being administered at the operator’s discretion.
Angiographic runs were obtained before and after the final treatment, with all patients having magnetic resonance (MR) or computed tomography (CT) imaging follow-up after 24 hours of treatment. In addition, clinical assessments were made using mRS and National Institutes of Health stroke scale (NIHSS) scores.
Zaidi relayed that, from a total population of 20 patients who initially achieved TICI 2b or 2c following a thrombectomy, two (10%) reached TICI 3 reperfusion—but, despite this, there was no change in the average final reperfusion score across the whole cohort. And, compared to age matched control group, the ALLY study indicated improved 90-day clinical outcomes with tenecteplase, as shown by a 50% rate of mRS 0–2 and a 60% rate of mRS 0–3 (versus roughly 40% and 50%, respectively, with controls).
At SVIN 2023, Zaidi concluded that—based on these mRS scores and the fact the drug was not associated with any major complications—the ALLY pilot study showed tenecteplase (1.5–4.5mg) to be a safe adjunct to mechanical thrombectomy in the setting of TICI 2b/c reperfusion. The speaker also stated that future randomised studies will be required to assess the efficacy of tenecteplase in these patient populations.
