ATTENTION LATE
(2025)Objective
To determine whether bridging intravenous tenecteplase prior to thrombectomy improves functional outcomes compared to direct thrombectomy alone in late-window (4.5–24 hours) basilar artery occlusion stroke patients.
Study Summary
• Bridging IV tenecteplase (0.25 mg/kg) before thrombectomy did not improve 90-day functional independence (mRS 0–2) compared to direct thrombectomy alone (rate ratio 0.92) in late-window basilar artery occlusion.
• No significant differences were observed across all secondary efficacy and safety endpoints including mortality, symptomatic ICH, and quality-of-life scores.
• Pre-thrombectomy reperfusion was more frequent with tenecteplase (5.4% vs 1.2%), but final post-procedural reperfusion rates were similar, suggesting thrombectomy's dominant treatment effect leaves little additional room for thrombolytic benefit.
• No significant differences were observed across all secondary efficacy and safety endpoints including mortality, symptomatic ICH, and quality-of-life scores.
• Pre-thrombectomy reperfusion was more frequent with tenecteplase (5.4% vs 1.2%), but final post-procedural reperfusion rates were similar, suggesting thrombectomy's dominant treatment effect leaves little additional room for thrombolytic benefit.
Intervention
Intravenous tenecteplase 0.25 mg/kg prior to thrombectomy vs. direct thrombectomy alone
Inclusion Criteria
Basilar artery occlusion stroke patients presenting 4.5–24 hours from symptom onset
Study Design
Arms: Bridging tenecteplase + thrombectomy vs. direct thrombectomy alone
Patients per Arm: 332 total (approximately 166 per arm)
Outcome
• No significant difference in 90-day functional independence (mRS 0–2); rate ratio 0.92.
• Secondary endpoints (mRS 0–1, 24-hour NIHSS, quality of life) and safety outcomes (90-day mortality, 72-hour ICH) were similar between groups.
• Subgroup analyses showed no benefit of bridging tenecteplase regardless of age, baseline NIHSS, occlusion location, or time to randomization.
• Secondary endpoints (mRS 0–1, 24-hour NIHSS, quality of life) and safety outcomes (90-day mortality, 72-hour ICH) were similar between groups.
• Subgroup analyses showed no benefit of bridging tenecteplase regardless of age, baseline NIHSS, occlusion location, or time to randomization.