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Randomized Controlled Trial
. 2025 Jun;10(2):618-623.
doi: 10.1177/23969873241286983. Epub 2024 Sep 30.

Adjunctive intra-arterial tenecteplase after successful endovascular thrombectomy in patients with large vessel occlusion stroke (POST-TNK): Study rationale and design

Jiacheng Huang  1   2 , Changwei Guo  2 , Jie Yang  2 , Xiaolei Shi  2 , Chang Liu  1   2 , Jiaxing Song  1 , Fengli Li  2 , Weilin Kong  2 , Shitao Fan  2 , Zhouzhou Peng  2 , Shihai Yang  2 , Jinfu Ma  2 , Xu Xu  2 , Linyu Li  2 , Zhixi Wang  2 , Nizhen Yu  2 , Wenzhe Sun  2 , Chengsong Yue  2 , Xiang Liu  2 , Dahong Yang  2 , Cheng Huang  2 , Duolao Wang  3 , Raul G Nogueira  4 , Thanh N Nguyen  5 , Jeffrey L Saver  6 , Yangmei Chen  1 , Wenjie Zi  2
Affiliations
Randomized Controlled Trial

Adjunctive intra-arterial tenecteplase after successful endovascular thrombectomy in patients with large vessel occlusion stroke (POST-TNK): Study rationale and design

Jiacheng Huang et al. Eur Stroke J. 2025 Jun.

Abstract

Rationale: Adjunct intra-arterial alteplase has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy. Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, could potentially enhance outcomes in stroke patients after successful reperfusion when used as an adjunct intra-arterial therapy.

Aim: To explore the safety and efficacy of intra-arterial tenecteplase after successful endovascular thrombectomy in patients with LVO stroke.

Sample size: To randomize 498 participants 1:1 to receive intra-arterial tenecteplase or no intra-arterial adjunctive thrombolysis therapy.

Methods and design: An investigator-initiated, prospective, randomized, open-label, blind-endpoint multicenter clinical trial. Eligible patients with anterior circulation LVO stroke presenting within 24 h from symptom onset (time last known well) and excellent to complete reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) scale 2c-3) at endovascular thrombectomy are planned to be randomized.

Outcomes: The primary outcome is freedom from disability (modified Rankin Scale, mRS, of 0-1) at 90 days. The primary safety outcomes are mortality through 90 days and symptomatic intracranial hemorrhage within 48 h.

Discussion: The POST-TNK trial will evaluate the efficacy and safety of intra-arterial tenecteplase in patients with LVO stroke and excellent to complete reperfusion.

Keywords: Large vessel occlusion stroke; endovascular thrombectomy; intra-arterial tenecteplase.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JLS reports consulting fees for advising on rigorous and safe clinical trial design and conduct from Biogen, Boehringer Ingelheim, Genentech, Johnson&Johnson, Phenox, Phillips, Rapid Medical, and Roche. TNN discloses Associate Editor of Stroke, advisory board of Aruna Bio and, Brainomix. RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Hyperfine, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, CrestecBio Inc., Euphrates Vascular, Inc., Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of ENDOLOW trial. Funding for this project is provided by Cerenovus. RGN is the Principal Investigator of the DUSK trial. Funding for this project is provided by Stryker Neurovascular. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, Tulavi Therapeutics, Vastrax, Piraeus Medical, Brain4Care, Quantanosis AI, and Viseon. Other author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Trial logo.
Figure 2.
Figure 2.
Study flowchart.
See this image and copyright information in PMC

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