Outcomes of mechanical thrombectomy following the Tenecteplase bridge therapy in acute large vessel occlusion stroke

Background & Objective: Growing evidence suggests that intravenous (IV) Tenecteplase (TNK) as bridging therapy before mechanical thrombectomy (MT) may facilitate recanalization and improve outcomes in acute large-vessel occlusion stroke (LVOS). This study evaluated the functional outcomes and identified the predictors of favorable outcomes in patients undergoing MT following TNK-bridge therapy in acute LVOS. Methodology: This was a retrospective observational cohort study conducted at the Department of Neuro-Endovascular Surgery, Punjab Institute of Neurosciences, Lahore, Pakistan, including all patients who underwent Tenecteplase (TNK) bridge therapy from November 2025 to April 2026. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27.0. Logistic regression was used to assess the predictors of functional outcome. Results: Of the total 30 patients, there was male predominance (76.70%, 23), with a mean age of 54.23±13.71 years. The median duration from onset of symptoms was 3.37 (2.91-4.00) hours. The most commonly affected vessel was the middle cerebral artery (MCA) (66.60%). Tandem occlusions were observed in 20.00% (6). The mean duration of the procedure was 75.63±17.11 minutes. Post-procedural intracranial hemorrhage was seen in 6.67% (2) cases. The overall first-pass effect (FPE) was 53.30%, and final successful recanalization was achieved in 90.00% (27) patients. The overall median reduction in National Institutes of Health Stroke Scale (NIHSS) score was 7.00 (IQR: 3.75-12.0), which was significant (p<0.001). Favorable outcomes at one month (modified Rankin Scale (mRS) = 0-2) were achieved in 36.70% (11). Low NIHSS score emerged as a significant independent predictor of favorable functional outcome (adjusted OR: 0.705, 95% CI: 0.514-0.967, p-value = 0.030). Conclusion: TNK bridge therapy offers potential benefits for neurological and functional outcomes. NIHSS at admission remained a powerful predictor of functional outcome.