The TEMPO-2 trial evaluated 886 patients within 12 hours of acute ischemic stroke with NIHSS 0 to 5 and large vessel occlusion and showed no difference in the primary functionality outcome. 36 The use of intra-arterial TNK has been explored in the BRETIS-TNK trial, which evaluated TNK intra-arterially in patients with large artery atherosclerosis undergoing mechanical thrombectomy and showed a trend to a higher reperfusion rate that was statistically significant after propensity score matching and a trend toward a better functional outcome. 44 Further trials are ongoing evaluating TNK in extended time windows (RESILIENT EXTEND-IV, ETERNAL-LVO, POST-ETERNAL), TNK as bridging therapy to endovascular treatments (DIRECT-TNK, BRIDGE-TNK), and adjunctive intra-arterial TNK (INSIST-IT, INSIST-TNK, ALLY, TECNO, BRETIS-TNK II, RESCUE-TNK, ATTENTION IA, ANGEL-TNK, EXTEND-AGNES TNK). 11 Two recent meta-analyses showed a superiority of TNK over alteplase in ischemic stroke.
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