ABSTRACT NUMBER: ESOC2026A519 BRIDGE-TNK SUBGROUP ANALYSIS: TNK PLUS ENDOVASCULAR THROMBECTOMY FOR AIS WITH TANDEM LESIONS

Abstract Background and aims Recent trials confirmed the efficacy and safety of intravenous tenecteplase as a bridging therapy prior to endovascular thrombectomy in acute ischemic stroke. For those with tandem lesion, who often require angioplasty and antiplatelet agents, thrombolysis may complicate the risk of hemorrhage and affect clinical outcomes, and whether tandem lesions alter tenecteplase’s effect remains unclear. This study aimed to explore how tandem lesions modify the effect of tenecteplase followed by thrombectomy via a post-hoc analysis of the BRIDGE TNK trial. Methods This is a post-hoc analysis of the BRIDGE TNK randomized trial. The primary outcome was functional independence at 90 days, defined as a modified Rankin scale score of 0 to 2, and assessed using modified Poisson regression. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and 90-day mortality. Results A total of 550 patients were included, 63 of whom had tandem lesions. Among patients without tandem lesion, 140 (54.1%) in the tenecteplase-plus-thrombectomy group and 94 (41.2%) in the thrombectomy-alone group achieved functional independence at 90 days (adjusted risk ratio: 1.28; 95% CI: 1.07–1.53). For those with tandem lesions, the rates were 7 (36.8%) and 26 (59.1%), respectively (adjusted risk ratio: 0.70; 95% CI: 0.36–1.37). Symptomatic intracranial hemorrhage and mortality rates were similar between groups in non-tandem patients; in tandem patients, tenecteplase plus thrombectomy correlated with higher mortality and numerically higher symptomatic intracranial hemorrhage risk. Conclusions Tandem lesions modified tenecteplase’s effect: in tandem patients, it did not improve outcomes and was linked to higher mortality. Conflict of interest Zhenyu Kong: nothing to disclose; Zhongming Qiu: nothing to disclose; Bo Yang: nothing to disclose; Thanh N. Nguyen: nothing to disclose; Jeffrey Saver: nothing to disclose; Tao Cui: nothing to disclose; Xiuli Wang: nothing to disclose; Hongfei Sang: nothing to disclose; Qingwu Yang: nothing to disclose.