ATTENTION-IA
Trial question
What is the role of intra-arterial tenecteplase after successful endovascular recanalization in patients with AIS due to posterior large or proximal vessel occlusion?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
25.0% female
75.0% male
N = 208
208 patients (51 female, 157 male).
Inclusion criteria: adult patients with AIS due to posterior large or proximal vessel occlusion.
Key exclusion criteria: prestroke disability; prestroke mRS score > 1; ICH; Posterior circulation Acute Stroke Prognosis Early CT Score < 6; contraindication to intravenous thrombolysis; severe renal failure; life expectancy < 1 year; ischemic stroke within 3 months; severe head trauma within 3 months.
Interventions
N=104 intra-arterial tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg, administered proximal to the residual thrombus or distal to the origin of the main pontine perforator branches over 15 seconds).
N=104 standard care (endovascular treatment only).
Primary outcome
Modified Rankin Scale score 0 or 1 at day 90
34.6%
26%
34.6 %
26.0 %
17.3 %
8.7 %
0.0 %
Intra-arterial
tenecteplase
Standard
care
No significant
difference ↔
No significant difference in mRS score 0 or 1 at day 90 (34.6% vs. 26%; RR 1.36, 95% CI 0.92 to 2.02).
Secondary outcomes
No significant difference in median mRS score distribution (4 points vs. 6 points; OR 1, 95% CI 0.61 to 1.62).
No significant difference in mRS score 0-2 at day 90 (38.5% vs. 40.4%; RR 0.93, 95% CI 0.67 to 1.28).
No significant difference in median NIHSS score at 24-72 hours (16 points vs. 16 points; MD 1.32, 95% CI -1.98 to 4.61).
Safety outcomes
No significant difference in death at day 90.
Conclusion
In adult patients with AIS due to posterior large or proximal vessel occlusion, intra-arterial tenecteplase was not superior to standard care with respect to mRS score 0 or 1 at day 90.
Reference
Wei Hu, Chunrong Tao, Li Wang et al. Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial. BMJ. 2025 Jan 14:388:e080489.
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